Diabetic Kidney Disease
Diabetic kidney disease takes many years to develop. In the first few years of diabetes, the kidneys filtering function remains normal. As the disease progresses, people who are developing kidney disease will have some amount of blood protein leak into their urine. This is the earliest sign of diabetic kidney disease. Over the years, more protein leaks into the urine. This is called proteinuria. With more protein leaking in the urine, the kidney’s filtering function drops. The body will then retain waste products as the filtering drops. This will cause further kidney damage, and will also cause the blood pressure to begin to rise.
Diabetes is the most common cause of kidney failure and affects more than 24 million people in the United States. It also affects people of different races. There are different factors that may cause diabetic kidney disease including hereditary, diet, and high blood pressure. Scientist have studied and learned that high levels of blood sugar and high blood pressure also increase the risk of a diabetic person to develop kidney disease.
People with diabetes should be screened regularly for kidney disease. There are two screening test that are recommended: Estimated Glomerular Filtration Rate or eGFR and Proteinuria. These are simple test obtained through blood and urine sample.
High Blood Pressure and Kidney Disease
Kidneys plays an important role in keeping a person’s blood pressure in a healthy range, and blood pressure, in turn, can affect the health of the kidneys. High blood pressure can damage the kidney and cause chronic kidney disease.
High blood pressure causes the heart to work harder, and overtime can damage the blood vessels all over the body. If the blood vessels in the kidneys are damaged, they may stop removing wastes and extra fluid in the body. This extra fluid in the blood vessels will also cause the blood pressure to rise even more. Blood pressure can be controlled in several ways or in combination of different ways including, keeping a good weight, controlling the amount of salt intake, eating healthy, getting plenty of exercise, and taking medications to control blood pressure.
Anemia is a condition commonly associated with Chronic Kidney Disease (CKD). It frequently develops as renal function decreases to less than 50% of normal, and is caused primarily by a deficiency in endogenous erythropoietin (EPO), a hormone produced in the kidney. Another factor responsible for this anemia of CKD is increased red blood cell (RBC) destruction. Since non-CKD causes of anemia, such as intestinal bleeding, can also occur, screening for such conditions is also important in patients with CKD and anemia.
Anemia can cause deterioration in cardiac function, result in the need for transfusions and hospitalizations, and contribute significantly to a reduction in quality of life. Therefore it is very important to monitor CKD patients for anemia, recognize it early, evaluate the causes and provide appropriate treatment.
Stimulation of RBC production is the cornerstone of anemia treatment in CKD patients, and 2 medications are available to provide this therapy, each administered via subcutaneous injection, usually every 2-3 weeks, more commonly known by their brand names as Procrit and Aranesp. NAMG provides administration of these medications to patients with CKD and anemia in each of our office locations.
Additionally, it is very common for patients receiving Procrit or Aranesp to develop iron deficiency during the course of their treatment due to accelerated use of existing iron stores in the process of producing new RBCs, even without blood loss.
While oral iron preparations are readily available over the counter, they are largely ineffective in maintaining adequate iron supply, and therefore intravenous iron replacement has become the treatment of choice.
NAMG provides this intravenous iron replacement for our CKD patients with anemia and iron deficiency at our office locations. Typically the treatment is every 1 to 2 weeks for 5 weeks, with additional periodic supplementation as determined by blood test results.