Kidney Disease because of Diabetes

Nowadays, Diabetes is the most common cause of kidney disease.

This has not laways been the case and indeed until about 10-15 years ago 9depending on what country you look at), most people who had kidney disease had this because of high bloodpressure or because of diseases like glomerulonephritis (see there).

We are currently facing an enormous wave of patients with diabetes in all countries of the world, but above all in the richer countries. there is a direct relation with overweight and indeed being too heavy is a strong predictor for becoming a diabetic patient. This is the so-called obesity epidemic. There is no improvement, in contrast, if you look around you, one notices the increasing number of obese people. Even more worrying, there are also more and more children with overweight, and even worse, we now diagnose young children with overweight-diabetes, a disease that in the past was only seen in adults.

Diabetes causes enormous damage to kidney. We dot know exactly why it is, but the first sign is the appearance of protein in the urine. This is something we chck in every patient with diabetes on a regular basis. The 1 million tiny filters in our kidneys are meant to let pass the waste products from our blood and let water pass, but the good substances, like proteins, should of course stay in the blood. The pores (holes) in the filter are tiny and proteins are big substances. When we see protein appearing on a urine test, be it with a stix or in the lab, then we know that the tiny holes have grown bigger, and protein can pass through and this is a clear sign that the filter-membrane is sick because of the diabetes. It is a very early sign that things are starting to become problematic.

With time, the proteins get stuck in the little filters, and they will give up their function. If we wait some years longer, we will see that our kidneys, that have tried hard to compensate for the worsening situation, will fail and we see the waste products in the blood creep up. We measure creatinine in the blood, one of the waste products, and if it is elevated it tells us how good the kidneys are still working.

A few years more and the kidneys will not be able anymore to sustain their function and we have total renal failure. Now we have to look at replacing the kidney function with dialysis, or better if possible, with transplantation of a kidney.

Why some people can go from a tiny bit of protein in the urine to total loss of kidney function in 5 yaesr, and others take 20 years, or even never get kidney failure at all, is still very unclear. what we know is that if you have several bad factors coming together, like diabetes, high blood pressure and poor bloodvessels that the process goes much faster.