What can be done once the kidneys have become damaged by diabetes?

Whilst many doctors feel that if we diagnose the presence of diabetic kidney disease early enough and take steps such as using drugs to minimize the microalbumin levels, we may even reverse the disease process. Although some others do not agree with this view, everyone is convinced that early and appropriate treatment can definitely delay the rate at which the disease progresses. The most important thing in the management of diabetic kidney disease (diabetic nephropathy) is the treatment of blood pressure if this should be high. Meticulous diabetic control can slow the progression of diabetic kidney disease.

This once again shows the importance of a regular check up with your doctor!

What happens if the kidneys fail completely?

If the kidneys become so damaged that only about 5% of overall kidney function remains, it is called end-stage kidney failure. The average time between the onset of diabetic kidney damage and end-stage kidney failure is variable and can be delayed by good management. For the diabetic person in a reasonable state of well-being, end-stage kidney failure can be treated by dialysis and/or transplantation.

How is end-stage kidney failure treated in diabetes?

The treatment of end-stage kidney failure involves what is called "Renal Replacement Therapy" Dialysis/haemodialysis (kidney machine) or peritoneal dialysis and kidney transplantation. The type of treatment chosen is determined by the general health and medical condition of the person, by its impact on the person's lifestyle and by the person's personal preference. Many people may receive each one of these three forms of treatment at various times. What may be the best treatment for one person at one time might not be the best for another or for the same person at a different time. The person's doctor will discuss these different treatments with the person and answer questions.

Renal Replacement Therapy

Dialysis

The two major forms of dialysis are hemodialysis and peritoneal dialysis.

Hemodialysis

In hemodialysis, your blood is sent through a machine that filters away waste products. The clean blood is returned to your body. Hemodialysis is usually performed at a dialysis center three times per week for 3 or 4 hours.

Peritoneal dialysis

In peritoneal dialysis, a fluid is put into your abdomen. This fluid, called dialysate, captures the waste products from your blood. After a few hours, the dialysate containing your body's wastes is drained away. Then, a fresh bag of dialysate is dripped into the abdomen. Patients can learn to do this themselves without going to a doctor's office each time. Patients using continuous ambulatory peritoneal dialysis (CAPD), the most common form of peritoneal dialysis, change dialysate four times a day. Another form of peritoneal dialysis, however, can be performed at night with a machine that drains and refills the abdomen automatically.

Transplantation

A donated kidney may come from an anonymous donor who has recently died or from a living person, usually a relative. The kidney that you receive must be a good match for your body. The more the new kidney is like you, the less likely your immune system is to reject it. Your immune system protects you from disease by attacking anything that is not recognized as a normal part of your body. So your immune system will attack a kidney that appears too "foreign." Special drugs can help trick your immune system so it does not reject a transplanted kidney.

Whilst tremendous strides have been made in improving the standards of renal replacement therapy, there is no treatment better than PREVENTION!

How YOU can help yourself!

Keep your blood sugar as close to normal as you can. Ask your doctor what blood sugar numbers are healthy for you.

Keep your blood pressure below 130/85 to help prevent kidney damage. Below 125/75 if you already have significant kidney disease!

Control your blood pressure

Follow the diet suggested by your doctor. Change your meal plan as your doctor and dietitian suggest. They might suggest you eat less protein, sodium, and potassium.

Have your kidneys checked at least once a year by having your urine tested for small amounts of protein ( microalbuminuria).

Have any other kidney tests that your doctor thinks you need. See a doctor for bladder or kidney infections right away. You may have an infection if you have these symptoms:

• Pain or burning when you urinate
• Frequent urge to go to the bathroom
• Urine that looks cloudy or reddish
• Fever or a shaky feeling
• Pain in your back or on your side below your ribs

Finally,

You may have no signs or symptoms even though your kidneys are affected. Which is why it is very important to see your doctor regularly and your doctor can check your urine for proteins especially microalbuminuria, see about your blood glucose control, check whether blood pressure is high, and detect diabetic eye problems.

Don't take your kidneys for granted!