The Kidney Connection Gil Grimes, MD June 22, 2007

The Kidney

Function The kidneys are powerful chemical factories that perform the following functions: –remove waste products from the body –remove drugs form the body –balance the body's fluids –release hormones that regulate blood pressure –produce an active form of vitamin D that promotes strong, healthy bones –control the production of red blood cells

How does it do that? Each kidney contains up to a million functioning units called nephrons. A nephron consists of a filtering unit of tiny blood vessels called a glomerulus attached to a tubule.

How does it do that? When blood enters the glomerulus, it is filtered and the remaining fluid then passes along the tubule. In the tubule, chemicals and water are either added to or removed from this filtered fluid according to the body's needs, the final product being the urine we excrete.

Kidney Facts The kidneys perform their life-sustaining job of filtering and returning to the bloodstream about 200 quarts of fluid every 24 hours. Two quarts are removed from the body in the form of urine, and about 198 quarts are recovered.

What does Diabetes do? With diabetes, the small blood vessels in the body are injured. When the blood vessels in the kidneys are injured, your kidneys cannot clean your blood properly. Your body will retain more water and salt than it should, which can result in weight gain and ankle swelling. You may have protein in your urine.

What does Diabetes do? Diabetes also may cause damage to nerves in your body. This can cause difficulty in emptying your bladder. The pressure resulting from your full bladder can back up and injure the kidneys. If urine remains in your bladder for a long time, you can develop an infection from the rapid growth of bacteria in urine that has a high sugar level.

What are some signs of damage? Albumin/protein in the urine High blood pressure Ankle and leg swelling, leg cramps Going to the bathroom more often at night High levels of BUN and creatinine in blood Less need for insulin or antidiabetic medications Morning sickness, nausea and vomiting Weakness, paleness and anemia Itching

How is it diagnosed? Blood testing yearly –The glomerular filtration rate –Blood Urea Nitrogen level (BUN) –Creatinine level Urine testing yearly –Microalbumin test Regular blood pressure checks

How is it prevented? Control your diabetes Control high blood pressure Get treatment for urinary tract infections Correct any problems in your urinary system Avoid any medicines that may damage the kidneys (especially over-the-counter pain medications like motrin, aleve, naprosyn)

How do I minimize the damage? Seeing a nephrologist, the kidney doctor –Together they will plan your treatment with you and you family, your family physician and your dietitian. Control your diabetes

How do I minimize the damage? Controlling high blood pressure in conjunction with an ACE inhibitor Following your renal diabetic diet. –Restricting protein in your diet also might be helpful. –You and your dietitian can plan your diet together.

Questions?