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Kidney Damage and High Blood Pressure

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The most serious complication of diabetes involving the urinary tract is nephropathy. Diabetic nephropathy is kidney damage that occurs in 20 to 30% of people with type 2 diabetes. If no action is taken to stop it, this condition can progress to end-stage renal disease. 80% of all people with end-stage renal disease have Type 2 diabetes, so diabetic nephropathy is a major concern for lifelong Type 2 diabetics.

Diabetes Can Weaken Your Kidneys:

Over time, diabetes causes damage to cell membranes in the kidney. These membranes are responsible for filtration and absorption of fluids and molecules. When membrane damage occurs at a filtration site, it starts to leak small amounts of protein into the urine.

Eventually the amount of protein being leaked from the kidneys increases to the point that the person has albuminuria (meaning the excretion is more than 300mg per 24 hr of protein). The kidneys' ability to filter fluid declines, and blood pressure starts to rise.

When albuminuria, hypertension and an inability of the kidneys to filter adequately are all present in the same person, diabetic nephropathy is indicated. The only treatments for renal failure are dialysis or a kidney transplant.

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Symptoms of nephropathy include:

  • swelling of the ankles, hands, face, or other body parts
  • loss of appetite possibly with a metallic taste in the mouth
  • skin irritations
  • difficulty in thinking clearly
  • fatigue
  • extreme difficulty managing blood sugar levels

Report any of these symptoms to the doctor who treats you.

Kidney Function Should be Checked Regularly:

Type 2 diabetics should have their kidneys checked every 12 to 24 months, or sooner if hypertension develops. Then:

  • blood tests should be carried out for serum creatinine levels to estimate the filtration rate
  • urine should be tested for protein and
  • blood pressure should be monitored

If blood sugar levels are controlled, blood pressure and blood lipid levels controlled... damage done to the kidneys can be prevented, slowed or stopped. Type 2 diabetics who have already progressed to albuminuria and have a declining filtration rate should consult a specialist.

Hypertension and Type 2 Diabetes:

Hypertension is a red flag even if kidney function is still on an even keel. People with hypertension are 2.5 times more likely to develop Type 2 diabetes than people with normal blood pressures, and the majority of people with Type 2 diabetes develop hypertension, demonstrating an obvious link. The combination of Type 2 diabetes and hypertension doubles a person's risk of cardiovascular disease.

Studies show that although Type 2 diabetics are at increased risk for heart disease, diabetics with hypertension benefit even more from controlling their blood pressure than their blood sugar. Fortunately, the same treatment for Type 2 diabetes will also help hypertension which is:

  • a healthy diet
  • exercise and
  • not smoking

Reducing the protein intake slightly can help as well.

Some Type 2 diabetics with hypertension will need medication to drop their blood pressure down to safe parameters. The most commonly prescribed type of drugs are angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs). Both drugs can also delay the development of diabetic kidney damage.


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Beverleigh Piepers RN... the Diabetes Detective.

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