Question

How does Diabetes (diabetes mellitus) play a role in kidney disease?

Answer 1

Diabetes mellitus is a clinical condition characterized by increased blood glucose level (hyperglycemia) due to insufficient or inefficient insulin. A healthy individual is capable of maintaining the blood glucose concentration within a narrow range. The fasting blood glucose level in a post-absorptive state is 70-100mg/dl (plasma glucose is 80-120mg/dl). The term hyperglycemia refers to an increase in the blood glucose above the normal level. Excretion of glucose in urine is known as renal glycosuria.

Kidneys play a special role in the homeostasis of blood glucose. Glucose is continuously filtered by the glomeruli, reabsorbed and returned to the blood. If the level of glucose in the blood is above 160-180mg/dl, glucose is excreted in urine (glycosuria). This value (160-180mg/dl) is referred to as renal threshold for glucose. The maximum ability of the renal tubules to reabsorb glucose per minute is known as tubular maximum for glucose (TmG). The value for TmG is 350mg/minute.

Diabetic kidney disease takes several years to develop. In various people, the filtering function of the kidneys is really higher than normal in the first few years of their diabetes. Over several years, people who are developing kidney disease will have small amounts of the blood protein albumin begin to leak into their urine. This first stage of (Course of Kidney Disease) CKD is called microalbuminuria. The kidney's filtration function generally remains normal during this period. As the disease improvements, more albumin leaks into the urine. This stage may be called proteinuria or macroalbuminuria. As the amount of albumin in the urine rises, the kidneys' filtering function usually begins to decreases. The body retains a variety of wastes as filtration falls. As kidney damage develops, blood pressure often rises as well.

Hypertension or, high blood pressure, is a major cause in the progress of kidney problems in people with diabetes. The family history of hypertension also causes increase chance of developing kidney disease. Hypertension also accelerates the development of kidney disease when it already exists.