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Diabetes Glossary

Diabetic Nephropathy

9 months, 2 weeks ago

3409  1
Posted on Sep 12, 2018, 8 p.m.

Kidneys are fist sized organs that filter 150-200 quarts of blood and produce 4-8 cups of urine every day. These workhorses remove waste, help maintain proper blood composition and fluid levels, and produce the active form of vitamin D as well as hormones needed for blood pressure control and red blood cell formation.

The kidneys contain around a million nephrons that are made up of looping glomeruli capillaries and collection tubules which filter blood, divert wastes and excess fluids to the bladder. If all these capillaries are laid end to end it is estimated that they would stretch over 100 miles.

Kidney function depends on robust blood flow through the nephrons, conditions that damage the blood vessels are the leading causes of chronic kidney disease, especially hypertension and diabetic nephropathy. Over 20 million Americans are affected by chronic kidney disease with most of them not even being aware of it.

Controlling blood sugar with weight loss, diet, exercise, healthy lifestyle changes, potassium and nitrate rich foods, supplements and multivitamins may help decrease the incidence of diabetic nephropathy and chronic kidney disease. Controllable risk factors include smoking, overuse of ibuprofen and other analgesics, proton pump inhibitors, and obesity.

Kidney problems are common among those with diabetes, one quarter to one third of those end up developing diabetic nephropathy. As blood is flowing through blood vessels in the kidneys waste products are filtered out to be excreted in urine, diabetes damages the kidneys causing the filtering system to fail. Excess blood sugar damages blood vessels in nephrons which are parts of the kidneys responsible for filtering blood, returning minerals, proteins, blood cells, and other constituents to circulation; and passing excess water and waste into tubules draining into the bladder. Useful proteins begin getting filtered into urine and eventually stress on the kidneys causes filtering abilities to completely fail, causing waste to build up in the blood creating the need for kidney dialysis. This is made even worse by excessive urination as many water soluble antioxidants and other nutrients that help to protect against kidney damage are lost in urine. There may be no symptoms until kidney function is drastically impaired, at this point symptoms include fluid build up, loss of sleep, lack of appetite, and weakness.

Treatment for kidney disease and diabetic nephropathy can be challenging, in addition to diabetes and blood pressure medications some diuretics, iron supplements, and drugs to boost red blood cells may be recommended. Statins may also be prescribed due to increased risk of CVD, however a recent 8 year study has linked statin use with higher incidence of acute and chronic kidney disease. Muscle mass can be improved with exercise, and water soluble vitamins and minerals can help stave off malnutrition. High sodium and protein intake does not cause kidney disease but they can accelerate progression of existing disease. There is no cure for advanced kidney disease, once it advances to end stage disease, or kidney failure, dialysis or transplant are the only options.

There are additional therapies that can help to slow down progression and improve kidney function such as a clinical trial involving more than 15,000 subjects with mild to moderate disease found that adding 800 mg of folic acid per day to drug therapy delayed progression. Other studies have demonstrated benefits of supplemental vitamin D and omega-3 fatty acids.

Kidneys and lungs are responsible for maintaining proper pH level in the body. If blood is too acidic the kidney produce bicarbonate to balance out the pH, if too alkaline they excrete it. Diseased kidneys are less efficient, acid levels may rise resulting in metabolic acidosis that worsens function and overall health. Subjects taking 600 mg tablets of baking soda 3 times a day for 2 days were shown to have decline in kidney function slowed and were able to tolerate more protein with gains in muscle mass, showing no signs of increase in blood pressure or edema.

Enhanced external counterpulsation is a noninvasive therapy that increases circulation and promotes new blood vessel growth throughout the body that has been shown to slow kidney disease and diabetic nephropathy even in those on kidney dialysis.

EDTA chelation helps to remove heavy metals from the body with several small studies showing it helps retard progression and improves markers of chronic kidney disease.

It is estimated that upwards of 400,000 Americans are currently undergoing dialysis, and more than 100,000 are on waiting lists for kidney transplants. Less than 17,000 kidney transplants are performed each year, kidney disease remains the 9th leading cause of death within the USA.

It is hoped that soon research will lead to advances in regenerating diseased kidneys with stem cell therapy and growing of new organs in lab or even creation of new kidneys via 3D printing. Until that day it is recommended to actively take steps to protect health and function of the kidneys, especially among those with diabetes.

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