The month of November jump starts the holiday season and includes Thanksgiving – a feast full of sweets and calories. November is also Diabetes Awareness Month. Whether or not this is coincidence, it is important to note that diabetes is a huge risk factor for kidney disease. Diabetes is the reason why more than 40% of patients are on dialysis today.
Even in this high-risk group there are a number of diabetics who have progressive kidney disease without the obvious signs of kidney disease in their urine. There is good news though – a new test which could identify kidney disease before it causes irreversible harm.
A current report in the New England Journal of Medicine has proposed a new method of diagnosing diabetic kidney disease before drastic deterioration in kidney function happens. This report utilized a blood test to measure soluble urokinase-type plasminogen receptor – a protein in the blood thankfully shortened to suPAR. This protein is in particular cells of the kidney. If the blood tests show high levels, there have been studies to indicate that there is inflammation in the kidney that has been connected to the onset and progression of kidney disease. In this study, patients at risk for heart disease, including diabetics, where tested for high blood levels of suPAR. In those with normal kidney function, a high test results was connected to a two- to three-fold increase in the chance of developing kidney disease. A high test result was also connected to a more rapid deterioration of kidney function during the duration of the study by over four-fold.
We commonly use protein in the urine (proteinuria) as an indicator of kidney disease in patients with diabetes. In this report, this connection was present with or without protein in the urine. Therefore, this could be a way to predict which patients with diabetes should be treated aggressively and early for diabetic kidney disease.
It has been revealed that treatment of early diabetic kidney disease with high blood pressure medications including ARB agents or ACE-inhibitors can slow the progression whether the patient has high blood pressure or not. Blood pressure control with these agents is a pillar of treatment. Blood pressure should be kept to less than 130/80. Diabetics should consume cholesterol lowering drugs to inhibit complications of heart disease and also to reduce the progression of kidney disease. Eating a healthy low-salt diet and increasing physical activity that encourages maintenance of a healthy body weight will also play a part in controlling diabetes and reducing the rate of progression of diabetic kidney disease.
It has been estimated that one-third of diabetics are undiagnosed. Other risk factors include smoking, lack of regular exercise, non-white ethnicity (especially Hispanic, American Indian and Asian), and obesity.