Diabetes Health: Protect Your Kidneys

Kidney problems related to diabetes may not be inevitable if you start with these preventive steps.


Three Steps to Prevent Kidney Problems

  1. Control your blood sugar. "Tight glucose control really does prevent or delay the onset of kidney disease," says Judith Benstein, M.D., a nephrology professor at the NYU School of Medicine. Talk to your health care provider about what your target levels should be.

  2. Take medications. Most people with diabetic kidney disease need to lower their blood pressure. The two types of medications most often prescribed are ACE inhibitors (angiotensin-converting enzyme inhibitors) and ARBs (angiotensin-receptor blockers). Both also can prevent or slow the progression of diabetes-related kidney disease, so health care providers may prescribe them to people at risk of diabetic kidney disease who have normal blood pressure.

  3. Monitor your blood pressure. Aim to get it below 130/80 mmHg. Even a small rise in blood pressure can quickly make kidney disease worse. For mild hypertension, your health care provider may recommend weight loss, exercise, consuming less salt, and avoiding tobacco and alcohol. There are many medications available to help lower blood pressure.

Early Diagnosis Is Crucial

By the time blood work found Shlomo Friedman's kidney disease, he was just eight months away from needing dialysis. Ten years after being diagnosed with type 2 diabetes, the 58-year-old salesman from Brooklyn, New York, had no signs that his kidneys were failing.

Unfortunately, his story is not unusual. "In general, symptoms aren't apparent until very late in the disease -- at or near the time dialysis is needed," says Ian H. de Boer, M.D., an assistant professor of medicine at the Kidney Research Institute at the University of Washington in Seattle.

"Diagnosing kidney disease early enough to make an impact relies on people getting their urine and blood tested regularly," he says. There are medications that can slow or stall the damage and keep kidneys going longer, he says, but "diagnosis is crucial." The American Diabetes Association recommends annual urine microalbumin tests for all people with type 2 diabetes and for people who've had type 1 diabetes for five years or more.

Know Your Risks

Early detection can help prevent kidney disease from progressing to kidney failure and the need for dialysis or transplant. It also can delay or prevent complications such as high blood pressure (another risk factor for kidney disease), anemia, nerve damage, and heart and blood vessel disease.

The kidneys -- essentially masses of blood vessels, each about the size of a fist -- filter the blood, removing waste products and excess salt and water. Diseased kidneys allow wastes to build up in the blood, which harms the body.

"Diabetes causes the kidneys to overwork," Benstein says. "The increased flow causes increased pressure, which in turn causes the damage to the tiny blood vessels."

Although more than 40 percent of people with diabetes will get kidney disease, most are not aware of the risk. Shlomo was one of them. "I had my head in the sand for a long time, and I paid dearly," he says.

After three years of dialysis, he had a kidney transplant. "I wish I'd taken my meds more seriously at the beginning of my diabetes. The high blood pressure was the worst offender. You feel good, so you think it can't be as bad as all that, but that's not true."

People with a family history of diabetes or kidney disease are at higher risk. Other risk factors include hypertension, obesity, chronically elevated blood glucose, smoking, and being an African-American, a Native American, or a Pacific Islander.