Damage to the filtering units of the kidneys that occurs in people who have diabetes mellitus
- Usually occurs in adults who have had diabetes mellitus for many years
- Diabetes mellitus sometimes runs in families
- Poor control of diabetes mellitus is a risk factor
- Gender is not a significant factor
Long-term diabetes mellitus may result in damage to various organs in the body. Kidney damage caused by diabetes mellitus is known as diabetic kidney disease. The disorder develops in about 4 in 10 of the people who have had diabetes for over 15 years.
Diabetes mellitus affects small blood vessels in the glomeruli (the filtering units of the kidney). Damage to these vessels causes protein to leak into the urine and reduces the kidneys’ ability to remove wastes and excess water from the body. Symptoms do not usually appear until kidney damage is severe, and may include drowsiness, vomiting, and shortness of breath (see Chronic kidney failure). Most people who have diabetes mellitus also have high blood pressure (see Hypertension), which may cause further damage to the kidneys.
What might be done?
People who have diabetes mellitus are monitored regularly by their doctor so that complications such as kidney damage can be detected at an early stage. The doctor will look for the first signs of diabetic kidney disease by arranging for urine tests to detect protein, and blood tests will be performed to check how well the kidneys are functioning. Once the condition has been diagnosed, the primary aim of treatment is to slow the progression of the disease to kidney failure. Good control of blood glucose and blood pressure are crucial to slow the deterioration of kidney function. However, even if diabetes is under control, diabetic kidney disease may still progress. Drugs called ACE inhibitors may be effective in slowing the progression of kidney disease due to diabetes mellitus. Nevertheless, the outcome may be end-stage kidney failure, in which there is a complete loss of function in both kidneys.
End-stage kidney failure due to diabetic kidney disease can often be treated with dialysis or a kidney transplant. It is sometimes possible to combine a kidney transplant with a transplant of the pancreas, treating both kidney failure and diabetes mellitus at the same time. However, the surgery involved is complex and is only carried out in certain specialist centres.
From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.
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