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>> Diabetes With Kidney Disease
 
Each year in the United States, more than 100,000 people are diagnosed with kidney failure, a serious condition in which the kidneys fail to rid the body of wastes. Kidney failure is the final stage of kidney disease, also known as nephropathy.

Diabetes is the most common cause of kidney failure, accounting for nearly 45 percent of new cases. Even when diabetes is controlled, the disease can lead to nephropathy and kidney failure. Most people with
diabetes do not develop nephropathy that is severe enough to cause kidney failure. About 18 million people in the United States have diabetes, and more than 150,000 people are living with kidney failure as a result of diabetes.

People with kidney failure undergo either dialysis, which substitutes for some of the filtering functions of the kidneys, or transplantation to receive a healthy donor kidney. Most U.S. citizens who develop kidney failure are eligible for federally funded care. In 2003, care for patients with kidney failure cost the Nation more than $27 billion.
African Americans, American Indians, and Hispanics/Latinos develop diabetes, nephropathy, and kidney failure at rates higher than Caucasions. Scientists have not been able to explain these higher rates. Nor can they explain fully the interplay of factors leading to diabetic nephropathy—factors including heredity, diet, and other medical conditions, such as high blood pressure. They have found that high blood pressure and high levels of blood glucose increase the risk that a person with diabetes will progress to kidney failure.
There are two types of diabetes. In both types, the body does not properly process and use food. The human body normally converts food to glucose, the simple sugar that is the main source of energy for the body’s cells. To enter cells, glucose needs the help of insulin, a hormone produced by the pancreas. When a person does not make enough insulin, or the body does not respond to the insulin that is present, the body cannot process glucose, and it builds up in the bloodstream. High levels of glucose in the blood lead to a diagnosis of diabetes. Both types of diabetes can lead to kidney disease.

Type 1 Diabetes
About 5 to 10 percent of people with diagnosed diabetes have type 1 diabetes, which tends to first occur in young adults and children. Type 1 used to be known as insulin-dependent diabetes mellitus or juvenile diabetes. In type 1 diabetes, the body stops producing insulin. People with type 1 diabetes must take daily insulin injections or use an insulin pump. They also control blood glucose levels with meal planning and physical activity. Type 1 diabetes is more likely to lead to kidney failure. Twenty to 40 percent of people with type 1 diabetes develop kidney failure by the age of 50. Some develop kidney failure before the age of 30.

Type 2 Diabetes
About 90 to 95 percent of people with diagnosed diabetes have type 2 diabetes, once known as noninsulin-dependent diabetes mellitus or adult-onset diabetes. Many people with type 2 diabetes do not respond normally to their own or to injected insulin—a condition called insulin resistance. Type 2 diabetes first occurs more often in people over the age of 40, but it can occur at any age—even during childhood. Many people with type 2 are overweight. Many also are not aware that they have the disease. Some people with type 2 control their blood glucose with meal planning and physical activity. Others must take pills that stimulate production of insulin, reduce insulin resistance, decrease the liver’s output of glucose, or slow absorption of carbohydrate from the gastrointestinal tract. Still others require injections of insulin in addition to pills.

The Course of Kidney Disease
Diabetic kidney disease takes many years to develop. In some people, the filtering function of the kidneys is actually higher than normal in the first few years of their diabetes. This process has been called hyperfiltration.

Over several years, people who are developing kidney disease will have small amounts of the blood protein albumin begin to leak into their urine. At its first stage, this condition has been called microalbuminuria. The kidney’s filtration function usually remains normal during this period.

As the disease progresses, more albumin leaks into the urine. This stage may be called overt diabetic nephropathy or macroalbuminuria. As the amount of albumin in the urine increases, filtering function usually begins to drop. The body retains various wastes as filtration falls. Creatinine is one such waste, and a blood test for creatinine can be used to estimate the decline in kidney filtration. As kidney damage develops, blood pressure often rises as well.

Overall, kidney damage rarely occurs in the first 10 years of diabetes, and usually 15 to 25 years will pass before kidney failure occurs. For people who live with diabetes for more than 25 years without any signs of kidney failure, the risk of ever developing it decreases.
 
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