I cannot go into the details of all the complications in this article; however I will discuss the main one. In my last article on diabetes, I outlined how damage to the blood vessels and nerves affect the lower limbs and cause gangrene and loss of the limbs. This week Iâll look at the effects of diabetes on the kidneys and the bladder.
The kidneys are affected mainly via the blood vessels in the organ. In the early stages, the patient has no problems, but the sugar poorly controlled. This causes an increase of blood to the kidney as the body tries to âwash outâ the sugar. The kidney is hyperperfused or is getting too much blood or is overworking. The overworking causes leakage of protein in the urine. The doctor may notice traces of protein in the urine and if he does not, he should test for it in the lab. Protein in the urine (called proteinuria) is an early sign that diabetes is affecting the kidneys. Diabetes affects the kidneys more if the sugar is poorly controlled or you have high blood pressure or you have a single kidney. Over a period of time, if the sugar is not properly controlled, the protein in the urine gets worse as the disease progresses. The strainer mechanism of the kidney starts getting âblocked upâ by the protein and the body starts destroying these âblockedâ units. Eventually the kidney shrivels and dies. At this stage, the person has chronic renal failure (end stage renal disease or ESRD) and needs dialysis. The time between the development of protein in the urine and ESRD is 5-10 years. That means the development of protein in the urine is an early sign of diabetic kidney disease. Diabetics also âpick upâ kidney infection. Repeated infections can cause scarring of the kidney and high blood pressure. The usual cause of the kidney infections is via bladder infections, as will be outlined below. Recurrent kidney infections can be prevented by proper sugar control.
Diabetics also pick up bladder infections because, as the diabetes progresses, poorly controlled, the nerves to the bladder are damaged. This means the bladder does not empty properly and the âretainedâ urine, which also has a lot of sugar, creates a perfect place for bacteria to grow. This causes bladder infections. The kidneys then get infection from the bladder. Diabetics who get bad or recurrent bladder and kidney infections tend to develop blood in the urine called hematuria. All the above kidney and bladder problems can be alleviated by diabetics making sure that their sugar is well controlled. Actually, if we see a diabetic with early kidney disease, we can reduce the rate of decline or even reverse some changes by proper diabetes control and the use of medications called ACEI or ARBs. Next week, I will continue to explore how diabetes affects the heart, blood and blood vessels.
For comments or question contact:
Dr Rohan Deshong
Tel: (784) 456-2785