What is Diabetes?How can Diabetes Affect the Kidney?What Tests are Needed?Is there Treatment if I have Diabetic Kidney Disease?What is Dialysis? Can I have a Transplant?How will my Life be Affected? 
Diabetes is a condition where the body does not control the sugar levels in the blood properly - the levels can go too high after meals, and too low if you do not eat. This information concentrates on diabetic kidney failure and cannot look in detail at treatments and other complications of diabetes. For further information on Diabetes please visit Diabetes UK.
An important complication of diabetes is kidney disease. The commonest problem is urine infection, which is much commoner in diabetes than the general population. It is usually treated well with antibiotics and better control of sugar levels.
However the most serious complication is diabetic kidney disease, which is not caused by infection. It occurs in up a to a third of diabetics, particularly those who have had diabetes for many years. A kidney affected by diabetes looks abnormal under the microscope with scarring and swelling in the filtering elements. This damage to the filtering elements causes protein to leak into the urine, which is an important marker for diabetic kidney disease.
The earliest sign of diabetic kidney disease is protein in the urine, and this should be tested for annually. If protein is found in the urine, and confirmed on a repeat test, control of the diabetes, blood pressure and cholesterol should be tightened, and attention to paid to a healthy lifestyle and losing weight if appropriate.
It is important to establish whether you have diabetic kidney disease, or another problem. A number of blood tests and an ultrasound scan of the kidneys will normally be performed. In some cases it may be necessary to perform a kidney biopsy to find the diagnosis. This is a test where doctors remove a small fragment of kidney with a needle, and there is usually an overnight stay in hospital (click here for more detail on kidney biopsy).
Diabetic kidney disease is not curable but doctors use treatments to try and stabilise the kidneys. Often the kidneys do gradually fail despite this treatment. However, this does not mean that the treatment is a failure. It will slow down the rate of kidney failure and help to keep the rest of you as fit as possible.
Blood pressure The kidneys are very sensitive to high blood pressure when they have diabetic disease. Since kidney disease causes high blood pressure, this means that nearly all diabetic patients with kidney trouble are on blood pressure drugs. Doctors try to use a type of blood pressure drug called ACE inhibitors, as these may provide special protection.
High blood pressure can damage not only the kidneys but also other parts of the body, so control of high blood pressure is vital.
Fluid retention Sometimes the kidney disease causes fluid retention and it is necessary to restrict the fluid intake a little and use tablets to force more fluid out of the kidneys.
See the Drugs pages for more detail on drugs used to control high blood pressure and fluid retention.
Control of sugar levels Good control of sugar levels is beneficial to the kidneys, and of course also very important to slow the rate of development of other types of diabetic complications.
Eye checks Most diabetics with kidney disease have some diabetic disease in the eyes, and there should be regular checks performed by a specialist.
Diet If you develop severe kidney failure, your diet will need further modification. Specialist dieticians will be able to advise on this. It is important that you eat well to keep your strength up, but there are some foods that can cause problems in kidney failure. Diabetics may need to be very careful about a foods containing potassium, which can cause heart problems if it gets to a very high level.
If the kidneys drop to less than about 10% of their normal function, there is fluid retention and build up of poisons in the body. At this stage dialysis, or artificial kidney treatment, may be necessary. There are two main types of dialysis, one where the blood is washed through a machine (haemodialysis), and another where fluid is passed in and out of the abdominal cavity to remove poisons (peritoneal dialysis).
The type of dialysis that might suit you best will be discussed with you by the kidney team who will try to give you as much information as you need.
The best treatment for someone with complete kidney failure is a transplant. The best type of kidney transplant is from a living donor, and if someone from the family, or a friend, offers a kidney this should be discussed with the kidney unit or local transplant coordinator (click here for more details of living donation). Although there is a severe shortage of kidneys available for transplantation, doctors also put as many people as possible on the list for a transplant from someone who has died.
In the last few years pancreas transplants have become much more successful. The transplantation of a pancreas from someone who has died may result in a cure for the diabetes, because the new pancreas is able to produce insulin. This means that insulin is not necessary and a normal healthy diet can be taken. Complications of diabetes, such as eye disease, usually stabilise. A pancreas transplant may be done at the same time as a kidney transplant, though people who already have kidney transplants may be suitable for a ‘pancreas after kidney’ transplant. Diabetics with juvenile onset diabetes taking insulin are suitable for pancreas transplants, providing they are physically otherwise fit. People with Type 2 diabetes who are taking tablets for control of their diabetes are generally not suitable for a pancreas transplant. This is because their bodies are resistant to insulin, so giving extra insulin through a transplant will not help.
Fitness for transplantation depends on how much diabetes has affected other parts of the body, particularly the heart. The transplant team will do a number of investigations, including heart tests, and the criteria for having a pancreas transplant are stricter than for a kidney transplant, because the operation is more stressful to the body.
Even on dialysis, many diabetic patients are able to lead active lives, working and enjoying life in many ways. If your diabetes has affected other parts of your body, you may have to accept these limitations.
Adapted from a leaflet written by Rob Higgins, Renal Consultant, Walsgrave Hospital, Coventry, 1998
NKF Controlled Document No. 55, Diabetes and the Kidney, written 1 July 2000. Last reviewed 25 September 2006.
The National Kidney Federation cannot accept responsibility for information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor.
Page created: 1 July 2000
Last updated: 29 May 2008
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