Good practice - renal

This section focuses on renal complications in diabetes care:

Introduction

One of the major complications that people with long-term diabetes face is kidney disease. Diabetic nephropathy, progressive kidney disease, is the medical term for the type of kidney disease that occurs in diabetes, and people with both Type 1 and Type 2 diabetes are at risk. It is estimated that one in three people with diabetes may go on to develop it. Read more on the Diabetes UK website: Diabetes UK: Kidneys (nephropathy).

 What is diabetic nephropathy?

Diabetic nephropathy is the deterioration of the kidneys. If a person's diabetes is not controlled properly, the tiny blood vessels which remove waste products from the body are damaged (microvascular damage). This damage causes kidney disease and ultimately kidney failure. The final stage of nephropathy is called end-stage renal disease, or ESRD.

Symptoms

There are no obvious symptoms in the early stages of diabetic nephropathy and damage to the kidneys may go undetected for several years. A deterioration in the function of the kidneys will result in the build up of waste products in the blood. The following symptoms may indicate a decrease in kidney function:

  • swelling (oedema) around parts of the body, including the legs, feet, ankles and the eyes.
  • unintentional weight gain (from fluid accumulation).
  • a poor appetite.
  • nausea and vomiting.
  • a general feeling of ill health.
  • tiredness.
  • headache.
  • breathlessness.
  • high blood pressure.

(Hasslacher and Böhm 2004).

The kidneys play a part in regulating blood pressure so damage to the kidneys can increase blood pressure which in turn can worsen the damage. The risk of nephropathy can be reduced by good diabetes management and the regular monitoring of:

  • blood pressure levels.
  • blood lipid levels.
  • blood glucose levels.
  • protein levels in urine.
  • cholesterol levels.

Checks on kidney function should be part of the annual review. If diagnosed at an early stage, early kidney damage can often be treated successfully.

References

Full details of the bracketed citation in the text above and, in many cases, links to the actual documents are available in the reference list within this resource. Go to the reference list.