Renal - key issues
Risk factors
The main identified risk factors for the development of diabetic renal disease are hereditary susceptibility (including ethnic orgin), elevated blood glucose levels and high blood pressure. Other suggested relationships are between diabetic renal disease and smoking, blood lipids, body mass index, age, sex and duration of diabetes (Klein et al 1995, Mattock et al 1998, John et al 1994). There are several tests available to detect elevated protein in the urine. Some of these tests measure albumin alone and others albumin/creatinine. Microalbuminuria, the presence of small traces of albumin in the urine, is an early indication of diabetic nephropathy.
Diagnosis
Early screening for microalbuminuria, the leakage of small amounts of protein (albumin) into the urine, is essential for all patients with diabetes. Microalbuminuria is a feature of diabetic renal disease, and it occurs due to elevated blood glucose and microvascular disease. This damage is detectable when protein is found in the urine in higher concentrations than normal. As the severity of damage to the kidneys increases so does the quantity of protein in the urine. Eventually the condition can lead to renal failure. People with diabetes are advised to have an annual microalbuminuria test. A kidney biopsis can confirm the diagnosis.
Treatment
The type of treatment recommended will depend on the individual. Lifestyle and dietary changes such as restricting the amount of protein in the diet is advised, and controlling blood pressure is also very important. People with diabetes who have above-normal levels of protein in their urine, may be given ACE inhibitor drugs or Angiotensin II receptor antagonists (AIIRAs). These drugs are particularly successful as they not only lower blood pressure but also help to slow the progression of kidney disease. Blood glucose levels should be closely monitored and controlled. This treatment is specifically referred to in the NSF standards for detection and management of long-term complications, as is the importance of tight control of blood glucose levels and raised blood pressure (Department of Health 2001b, page 41). For further information on these drugs go to the Diabetes UK website: Diabetes UK: Ace inhibitor drugs and Diabetes UK: Angiotensin II receptor antagonists (AIIRAs) .
Prognosis
A patient’s prognosis will depend on how early the disease is caught, however, once diabetic nephropathy has started it tends to progress. The treatment is designed to slow down the progression of the disease as much as possible and adherence to treatment is essential. In general, the earlier and more aggressive the treatment, the slower the progression, and the longer a patient can avoid kidney dialysis.
Support
NHS Diabetes
NHS Diabetes works to raise the quality of diabetes care in England by supporting and working with the health care community and people with diabetes. The team’s role is to ensure the delivery of the Diabetes National Service Framework – a Government pledge to improve diabetes care in England across the board by 2013.
Formerly the National Diabetes Support Team, the organisation was re-launched in early 2009 with fresh objectives. Visit: NHS Diabetes
NHS Kidney Care
NHS Kidney Care works with clinical teams and commissioners to transform services available to those with kidney disease, helping to develop and support new guidelines, standards and systems designed to improve care. NHS Kidney Care is also working to ensure the implementation of the National Service Framework for Renal Services, a government pledge to improve quality of care for kidney patients in England by 2014. NHS Kidney Care produces an e-newsletter called Kidney Care Matters. View Kidney Care Matters.
References
Full details of the bracketed citations 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.
For more information, go to: renal.