1. Renal Complications Associated with Diabetes By Gabriella Benavides FNP-BC

2. Your Kidneys and What They Do Kidneys are two bean-shaped organs abut the size of your fist. Kidneys are two bean-shaped organs abut the size of your fist. They are located on either side of the spine, just below the rib cage They are located on either side of the spine, just below the rib cage Your kidneys perform several important functions: Your kidneys perform several important functions: Filter your blood to remove waste and excess fluid Filter your blood to remove waste and excess fluid Control making of red blood cells Control making of red blood cells Help control blood pressure Help control blood pressure Help control the amounts of calcium, potassium, and phosphorus in the body. Help control the amounts of calcium, potassium, and phosphorus in the body.

3. Common Causes of Kidney Disease A history of uncontrolled Diabetes. A history of uncontrolled Diabetes. A history of high blood pressure, especially if poorly controlled A history of high blood pressure, especially if poorly controlled Repeated kidney infections Repeated kidney infections Immune disease of the Kidney like glomerulonephritis Immune disease of the Kidney like glomerulonephritis Heredity like polycystic kidneys Heredity like polycystic kidneys Others, for example Alport Syndrome Others, for example Alport Syndrome

4. Who Gets Kidney Disease Not everyone with diabetes develops kidney disease. Factors that can influence kidney disease development include genetics, blood sugar control, and blood pressure. Not everyone with diabetes develops kidney disease. Factors that can influence kidney disease development include genetics, blood sugar control, and blood pressure. The better a person keeps diabetes and blood pressure under control, the lower the chance of getting kidney disease. The better a person keeps diabetes and blood pressure under control, the lower the chance of getting kidney disease.

5. How Does Diabetes Cause Kidney Disease When our bodies digest the protein we eat, the process creates waste products. In the kidneys, millions of tiny blood vessels (capillaries) with even tinier holes in them act as filters. As blood flows through the blood vessels, small molecules such as waste products squeeze through the holes. When our bodies digest the protein we eat, the process creates waste products. In the kidneys, millions of tiny blood vessels (capillaries) with even tinier holes in them act as filters. As blood flows through the blood vessels, small molecules such as waste products squeeze through the holes. These waste products become part of the urine. Useful substances, such as protein and red blood cells, are too big to pass through the holes in the filter and stay in the blood. These waste products become part of the urine. Useful substances, such as protein and red blood cells, are too big to pass through the holes in the filter and stay in the blood.

6. How Does Diabetes Cause Kidney Disease Diabetes can damage this system. High levels of blood sugar make the kidneys filter too much blood. All this extra work is hard on the filters. Diabetes can damage this system. High levels of blood sugar make the kidneys filter too much blood. All this extra work is hard on the filters. After many years, they start to leak and useful protein is lost in the urine. Having small amounts of protein in the urine is called microalbuminuria. After many years, they start to leak and useful protein is lost in the urine. Having small amounts of protein in the urine is called microalbuminuria.

7. How Does Diabetes Cause Kidney Disease When kidney disease is diagnosed early, during microalbuminuria. When kidney disease is diagnosed early, during microalbuminuria. Having larger amounts of protein in the urine is called macroalbuminuria. Having larger amounts of protein in the urine is called macroalbuminuria. When kidney disease is caught later during macroalbuminuria, end-stage renal disease, or ESRD, usually follows. When kidney disease is caught later during macroalbuminuria, end-stage renal disease, or ESRD, usually follows.

8. How Does Diabetes Cause Kidney Disease In time, the stress of overwork causes the kidneys to lose their filtering ability. Waste products then start to build up in the blood. Finally, the kidneys fail. In time, the stress of overwork causes the kidneys to lose their filtering ability. Waste products then start to build up in the blood. Finally, the kidneys fail. This failure, ESRD, is very serious. A person with ESRD needs to have a kidney transplant or to have the blood filtered by machine (dialysis) This failure, ESRD, is very serious. A person with ESRD needs to have a kidney transplant or to have the blood filtered by machine (dialysis)

9. What Happens to the Body when Developing Kidney Disease Build up of fluid water and waste products in your blood causing swelling and generally not feeling well Build up of fluid water and waste products in your blood causing swelling and generally not feeling well Chemical in balances: Potassium, Sodium, Phosphorus, Calcium Chemical in balances: Potassium, Sodium, Phosphorus, Calcium Loss of hormone production that helps: control your blood pressure, build red blood cells, keep your bones strong Loss of hormone production that helps: control your blood pressure, build red blood cells, keep your bones strong

10. Symptoms of Chronic Kidney Disease Nausea poor appetite, and weight loss Nausea poor appetite, and weight loss Trouble of sleeping Trouble of sleeping Loss of Concentration Loss of Concentration Dry, itchy skin Dry, itchy skin Swelling of face, hands, and feet Swelling of face, hands, and feet

11. Symptoms of Kidney Disease Swelling of face, hands, and feet Swelling of face, hands, and feet Cramping at night Cramping at night Difficulty breathing Difficulty breathing Tiredness and weakness Tiredness and weakness

12. Patients With kidney Disease Need to Know Early diagnosis & treatment helps slow the disease process Early diagnosis & treatment helps slow the disease process It’s important to learn about the available treatments now before therapy is needed It’s important to learn about the available treatments now before therapy is needed You can take an active role in deciding with your patients the best choice in therapy to meet your patients medical needs and lifestyle preferences. You can take an active role in deciding with your patients the best choice in therapy to meet your patients medical needs and lifestyle preferences. Managing your patients disease will help determine the quality of your patients life. Managing your patients disease will help determine the quality of your patients life. Your patients always have the right to refuse treatment. Your patients always have the right to refuse treatment.

13. How can I Prevent Kidney Disease Diabetic kidney disease can be prevented by keeping blood sugar in your target range. Diabetic kidney disease can be prevented by keeping blood sugar in your target range. Research has shown that tight blood sugar control reduces the risk of microalbuminuria by one third. Research has shown that tight blood sugar control reduces the risk of microalbuminuria by one third. In people who already had microalbuminuria, the risk of progressing to macroalbuminuria was cut in half. Other studies have suggested that tight control can reverse microalbuminuria. In people who already had microalbuminuria, the risk of progressing to macroalbuminuria was cut in half. Other studies have suggested that tight control can reverse microalbuminuria.

14. Management of Kidney Disease Important treatments for kidney disease are tight control of blood glucose and blood pressure. Important treatments for kidney disease are tight control of blood glucose and blood pressure. Blood pressure has a dramatic effect on the rate at which the disease progresses. Even a mild rise in blood pressure can quickly make kidney disease worsen. Blood pressure has a dramatic effect on the rate at which the disease progresses. Even a mild rise in blood pressure can quickly make kidney disease worsen. Four ways to lower your blood pressure are losing weight, eating less salt, avoiding alcohol and tobacco, and getting regular exercise. Four ways to lower your blood pressure are losing weight, eating less salt, avoiding alcohol and tobacco, and getting regular exercise.

15. Managing Kidney Disease Diet and Medication Diet and Medication Dietary changes help decrease the fluid and waste build up that the kidneys can no longer remove Dietary changes help decrease the fluid and waste build up that the kidneys can no longer remove Medications replace some of the functions that the kidneys can no longer do: Control blood Pressure, make red blood cells, keep bones health and strong Medications replace some of the functions that the kidneys can no longer do: Control blood Pressure, make red blood cells, keep bones health and strong

16. Diet Another treatment some doctors use with macroalbuminuria is a low-protein diet. Another treatment some doctors use with macroalbuminuria is a low-protein diet. Protein seems to increase how hard the kidneys must work. Protein seems to increase how hard the kidneys must work. A low-protein diet can decrease protein loss in the urine and increase protein levels in the blood. Never start a low- protein diet without talking to your health care team A low-protein diet can decrease protein loss in the urine and increase protein levels in the blood. Never start a low- protein diet without talking to your health care team

17. Drugs When these methods fail, certain medicines may be able to lower blood pressure. There are several kinds of blood pressure drugs, however, not all are equally good for people with diabetes. When these methods fail, certain medicines may be able to lower blood pressure. There are several kinds of blood pressure drugs, however, not all are equally good for people with diabetes. Some raise blood sugar levels or mask some of the symptoms of low blood sugar. Doctors usually prefer people with diabetes to take blood pressure drugs called ACE inhibitors. Some raise blood sugar levels or mask some of the symptoms of low blood sugar. Doctors usually prefer people with diabetes to take blood pressure drugs called ACE inhibitors.

18. Drugs ACE inhibitors are recommended for most people with diabetes, high blood pressure and kidney disease. ACE inhibitors are recommended for most people with diabetes, high blood pressure and kidney disease. Recent studies suggest that ACE inhibitors, which include captopril and enalapril, slow kidney disease in addition to lowering blood pressure. Recent studies suggest that ACE inhibitors, which include captopril and enalapril, slow kidney disease in addition to lowering blood pressure. In fact, these drugs are helpful even in people who do not have high blood pressure. In fact, these drugs are helpful even in people who do not have high blood pressure.

19. Drugs People with chronic kidney disease may retain fluids. This can lead to swelling in the legs, as well as high blood pressure. Medications for example Lasix can help maintain the balance of fluids in your body. People with chronic kidney disease may retain fluids. This can lead to swelling in the legs, as well as high blood pressure. Medications for example Lasix can help maintain the balance of fluids in your body.

20. Drugs Your doctor may prescribe calcium and vitamin D supplements to prevent weak bones and lower your risk of fracture. You may also take medication to lower the amount of phosphate in your blood, to protect your blood vessels from damage by calcium deposits (calcification). Your doctor may prescribe calcium and vitamin D supplements to prevent weak bones and lower your risk of fracture. You may also take medication to lower the amount of phosphate in your blood, to protect your blood vessels from damage by calcium deposits (calcification).

21. The progression of Kidney Disease Kidney disease is a progressive disease that advance from stage I through Stage V Kidney disease is a progressive disease that advance from stage I through Stage V Stage V CKD or End –Stage Renal Disease is commonly referred to as Kidney failure Stage V CKD or End –Stage Renal Disease is commonly referred to as Kidney failure Diabetes is the number one cause of CKD, followed by Hypertension. Diabetes is the number one cause of CKD, followed by Hypertension.

22. Kidney Failure Once kidneys fail, dialysis is necessary. The person must choose whether to continue with dialysis or to get a kidney transplant. Once kidneys fail, dialysis is necessary. The person must choose whether to continue with dialysis or to get a kidney transplant. This choice should be made as a team effort. The team should include the doctor and diabetes educator, a nephrologist (kidney doctor), a kidney transplant surgeon, a social worker, and a psychologist. This choice should be made as a team effort. The team should include the doctor and diabetes educator, a nephrologist (kidney doctor), a kidney transplant surgeon, a social worker, and a psychologist.