Diabetes and the Kidneys

The kidneys serve as filters of the blood. They remove wastes, maintain electrolyte (ex. potassium, sodium, magnesium) balance, and manage body water to form urine which is expelled from the body
In addition to filtering the blood, they play a prominent role hormonally.
- The kidneys function in blood pressure control, red blood production, and even bone
  maintenance
High blood glucose and high blood pressure damage the vessels in the kidneys. This can impact their ability to effectively filter the blood and perform their hormonal functions. As a result, protein and glucose can spill into the urine and hormonal complications can occur.
Most people with kidney damage (also known as nephropathy) do not show symptoms in the early stages
In the later stages edema and fluid retention, anemia, and hyperparathyroidism can occur. In addition, your body may begin to experience metabolic complications such as acidosis. Failing kidneys impact multiple organ systems (such as the heart and lungs) and can severely impact your quality of life

Diabetes is the leading cause of kidney failure in Antigua and Barbuda
Approximately 25% of individuals with diabetes develop some form of kidney disease
The progression of kidney disease is usually quite slow but this depends on blood sugar control and genetic factors
To monitor kidney health, your physician looks for the presence of a protein called albumin in your urine. Normally, there should be no albumin in your urine. If your albumin is over 30, the doctor will say you have microalbuminuria. This indicates that you have early nephropathy.
- The presence of microalbuminuria is important as it serves as a risk factor for other complications of diabetes such as poor heart health and eye complications

As the kidneys become more damaged, the amount of protein in the urine increases. Once you get to 300 or greater, this known as proteinuria. This indicates that you have late nephropathy.
- Besides measuring the albumin in your urine, your physician will also look at the ratio of albumin to a waste product known as creatinine (ACR) and check your glomerular filtration rate (GFR)

Managing your Kidney Health

Medications, lifestyle management, and good blood sugar control can help preserve the function of the kidneys and prevent kidney failure
- Be sure to discuss your kidney health with your physician at each appointment
- Know your sugar targets and blood pressure. Try to meet these targets as they can help you to maintain your kidney health
- Work with your dietitian and/or family doctor to come up with a meal plan/renal diet which promotes kidney health
- Limit the use non-steroidal anti-inflammatory medications such as ibuprofen (Brand names Advil, Motrin) and naproxen (Brand name Aleve) unless you have first discussed these medications with your family doctor. They can reduce kidney function when used chronically.

Testing and Kidney Function

Albumin
- Normal kidney function (Urine microalbumin/Cr ratio: less than 30 mg/g Cr)
- Early Nephropathy (Urine microalbumin/Cr ratio: 30-300 mg/g Cr)
- Late Nephropathy (Urine microalbumin/Cr ratio: more than 300 mg/g Cr

Glomerular filtration rate
- A GFR of 60 or higher is in the normal range.
- A GFR below 60 may mean you have kidney disease.
- A GFR of 15 or lower may mean kidney failure.