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    Nancy Klobassa Davidson, R.N., and Peggy Moreland, R.N.

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  • Living with diabetes blog

  • March 11, 2011

    Kidney disease: No early symptoms

    By Nancy Klobassa Davidson, R.N., and Peggy Moreland, R.N.

28 comments posted

Controlling Your Diabetes

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This blog is in response to a reader question about the symptoms of kidney disease that we received about our blog, "With diabetes, kidney care is crucial."

In some people with diabetes, over time, high blood glucose levels can damage the millions of tiny blood vessels that filter waste from the blood and dispose of it in the urine. Unfortunately, early kidney disease has no symptoms. Generally, not until the damage is extensive do symptoms emerge.

Symptoms of advanced kidney disease include:

  • Swelling of ankles, feet and hands
  • Shortness of breath
  • High blood pressure
  • Confusion or difficulty
  • Poor appetite
  • Nausea and vomiting
  • Dry, itchy skin
  • Fatigue

To identify kidney problems early, an important part of your yearly diabetes management checkup is getting what's called a urine microalbumin test. This test measures the amount of a protein, albumin, in your urine.

When kidneys are functioning normally, they filter out only waste in your blood, excreted in your urine. Protein and other helpful substances remain in your bloodstream. When your kidneys become damaged, waste products remain in your blood, and albumin leaks into your urine.

When your kidneys are in early distress, only small amounts of albumin escape into the bloodstream. You may lose 30 to 300 milligrams (mg) of albumin a day through the urine. This condition is called microalbuminuria. In advanced stages of kidney disease, you might lose more than 300 mg of albumin a day.

The most reliable test to screen for microscopic protein in the urine is to collect the urine in a container for 24 hours. Another available test, the random microalbuminuria test, requires only a one-time sample of urine.

If your health care provider is aware of early kidney disease through such testing, early treatment measures can help prevent or slow down the progression of diabetes-related kidney disease. Treatment measures include:

  • Keeping blood glucose levels in a healthy target range, as determined by your doctor
  • Maintaining a healthy blood pressure level, as determined by your doctor
  • Starting an ACE inhibitor blood pressure medication, which has protective benefits to the kidneys
  • Eating a low-protein diet

Your comments are appreciated.

Have a great week,
Nancy

28 comments posted

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  • January 19, 2013 8:16 p.m.

    i went to the dr. for my routine blood work and for sugar intake the sae day a few hours later the nurse calls and tells me my sugar is stable. around three that evening they called and told me that my 6 mths check up was due. they precided to tell me they found protein in my urine ,ok she started to make the appointmentand she told me to wait and came back and said that they neededto see me on the monday comin up which this was on friday and i am totally scared what should be helpful for me to know.

    - kathy

  • December 18, 2012 6:48 a.m.

    what if you have few systoms for kidney failure like ,fatigue , uncontrolled diabetes bec of other meds ,swelling of feet only. Does that mean one has early signs ?

    - Teena

  • August 7, 2012 1:15 a.m.

    what causes a person with diabetes to not be able to urineate correctly

    - Jo

  • July 15, 2012 9:57 a.m.

    I know a woman who I believe is in kidney failure. She refuses to see a doctor because of her religious beliefs. My question is this. How long can she live if she is in stage 3 failure. I really need to know because she is very dear to me and I live very far from her. I want to make sure I am near her before something happens. Thank You

    - Monica

  • July 1, 2012 5:34 a.m.

    When your doctor does a full blood test and urinalysis, will kidney disease show up if present?

    - Barbara

  • May 1, 2012 5:01 p.m.

    My mom is 80 and has Diabetes and her legs and feet are very swollen, the Doctor hasn't seen her in a while, she goes to an Indian Clinic and doesn't seem they care, what should we do? She also has RA and is on Remicade and needs a hip operation and doesn't move around much, we are very concerned.

    - Faye

  • April 22, 2012 1:37 p.m.

    As a human nutrition student, I have always know the benefits of incorporating dietary fiber into one’s diet. But I always wondered what the dietary fiber requirements were for patients who suffered from a chronic disease, e.g., Chronic Kidney Disease. So I interviewed a fellow researcher and got some insight. There may be potential benefits in lowering the stage of CKD with adequate fiber intake: http://publichealthbugle.com/2012/04/younis-salmean/

    - Ali

  • November 17, 2011 3:29 p.m.

    My mother has just been diagnosed with 3rd stage kidney disease and has no symptoms. A few months ago her bun creatinine was normal and, now, that and her GFR are very elevated. It happened very quickly.

    - CAROLYN

  • October 22, 2011 3:52 p.m.

    I am 40 yrs. old, had a transplant at age 7. I have had my kidney for 30 yrs. Recently I could not get my BP down and had a severe headache. One doctor told me I should not jump into dialysis and another doc., a nephrologist, said I needed to go on dialysis. I ended up on dialysis the next day even though this is not what I wanted. I had had this situation before and got the headache under control but this time I ended up in the hospital 24 hrs but they did not do the 24 hour urine clearance or let me just see how I would do without dialysis. The nephrologist insisted that I go to dialysis and now I have all this medicine, all the symptoms you can think of with kidney failure but still urinate. I have not slept in two years and now have swollen feet. I've never had swollen feet before and am wondering if I am worse off as I've lost 30 lbs in those years and cannot gain it back. I don't know what to do as I am not getting better but worse. They are giving me 20,000 units of epogen at once and I had a slight cardiovascular problem to where I slurred my speech, my pulse went to over 120 and have a catheter in my juglar vein for over those 2 years. I'm wondering if my nephrologist made a mistake and the other doctor was right. Do you think it would be risky to get off dialysis and see how I do? Thanks. If I had this to do over, I would never go on dialysis unless I knew for sure this was the right thing. Your life changes in ways you just cannot fathom.

    - Jim

  • October 17, 2011 5:49 p.m.

    My blood creatinine level went from 1.9 to 2.1. The 1.9 level did not concern my physicians - who consulted with a nephrologist - because I only have one kidney left. Now my blood creatinie level, in just a few months, went to 2.7. However, my 24 hour urine sample shows my creatinine level to be in the normal range? Huh? Which is more important - my blood cretainine level or my 24 hour urine level?

    - Wolfgang

  • October 5, 2011 9:03 a.m.

    I have Hyperkalemia--Does this disease afect the kidney. My feet and lower legs feed like they are asleep.

    - Ellen

  • September 29, 2011 12:32 a.m.

    I am not sure what is going on with me. I have a bulging disc in my low back which is pinching my sciatic nerve and I have been in extreme pain for a month now. I have been taking Norco or percoset to control the pain. I have noticed recently that I have swelling on my left side between the ribs and the hip. My left thigh is swollen, my feet are huge, and my face is pretty puffy. The doctor just informed me that my x-ray from a month ago showed that I have kidney stones. Could this be the cause of my swelling? I have never had stones before. A few of my close friends are amazed at how swollen my body is. This is all new to me and not sure when or who to see. Any help or suggestions would be appreciated. Thank You...

    - Susan

  • August 21, 2011 9:42 p.m.

    what happens if you are prescribed metformin for type 1 diabetes? When you are on dialysis?

    - Donna

  • August 4, 2011 9:08 p.m.

    wow very interesting... i sit at a desk every day and i have most of the symptoms including my feet, especially my toes, turning purple at the end of the day. now after reading your info i will make an appt with my doctor. thank you for making this available to everyone.

    - jo

  • August 4, 2011 12:06 a.m.

    What is Bilateral renal parenchymal disease

    - Alexander

  • May 24, 2011 2:55 p.m.

    Jan- Insulin is the best choice for controlling the blood glucose with diabetic individuals in chronic renal failure (CRF), if your father is not on insulin he should be. Even on insulin it can be difficult to control the blood glucoses with CRF since the kidneys aren't functioning properly. Follow-up with your provider.

    - Nancy and Peggy

  • May 19, 2011 11:09 a.m.

    My dad has chronic kidney disease. He also has Diabetes which has become out of control. His blood sugar before a meal is going over 400. His doctor has been adjusting his medications for that but nothing seems to work. Any thoughts or things that worked for anyone out there?

    - Jan

  • April 22, 2011 5:54 p.m.

    My child got diabetes type 1 from Mono. He/She gets sick often and has problems with being tired. It takes them a long time to get over viruses/infections. A normal person sick 1 day they will be sick 4 -5 days. Since diagnosed every year gets sick at about the same time (mono symptons) and just over all does not feel good. We have done many tests and find nothing. He/She has tested postive for the mono 2 yrs in row, go to specialist and say never had mono. Is their anyone else that this has happened to?

    - lb

  • April 15, 2011 6:50 p.m.

    does diabetes cause mood swings?

    - Carrie

  • March 29, 2011 1:16 p.m.

    Kippy, ask for an appointment to see a dietitian. If the kidneys are not working properly, they have a difficult time breaking down protein. You will need to get your energy from other sources then mostly protein.

    - Nancy and Peggy

  • March 29, 2011 11:32 a.m.

    Kidney disease can be sudden short-term (acute) or progressive long-term (chronic). Check with your physician as to the type of kidney disease you have. Additional tests may need to be done to determine this. Remember: if interventions are started early they can prevent the onset of Chronic Kidney Disease (CKD)

    - Nancy and Peggy

  • March 27, 2011 12:48 p.m.

    Does coffee drinking cause or contribute to kidney damage?

    - mickey

  • March 21, 2011 12:20 p.m.

    I have been told by my Kidney Dr. that I need to have a port installed now. How soon does a person need to have the stomach port for home dialysis when its time for dialysis? What type of Doctor does this type of surgery?

    - John

  • March 16, 2011 4:42 p.m.

    As with the previous commenters, I find it difficult to balance more than one health issue and be good to my kidneys. I take Lisonopril to help with High Blood Pressure and fluid retention. I take Levothyroxine for Hypothyroidism. I take Metformin and need insulin to help control my Type 2 Diabetes. I take Simvistation to help with with Cholesterol issues. I need Advair, Singulair and Albuterol to manage my Athsma. The Amitriptyline is prescribed to help me sleep, manage pain better and treat mild depression. I take Tetracycline every day to prevent skin infections. I take Cyclobenzaprine and Tramadol to help lessen the relentless pain and muscle tension from Neuropathy and Fibromyalgia. I check my glucose levels at least 5 times a day to try to manage them closely. I take doctor prescribed CoQ10, Vitamin C, Vitamin D and a MultiVitamin. It's a full time job to keep track of taking pills and other meds. I'm exhausted. I sleep poorly. I barely have time and energy for family and pets. I don't think I'll ever be able to have a social life again. And I don't know what to do to further improve my situation. Thanks for your time.

    - Linda

  • March 16, 2011 4:30 p.m.

    When I first learned that I have severe kidney disease I was grossly over weight. My sodium intake was reduced and I lost over 40 pounds. I went from borderline stage 5 kidney disease to borderline 3/4. I also have chronic anemia which I have been told is one of the things that can and does go along with the kidney. I receive a shot every 3 weeks to stimulate my body to make blood, which it no longer does without the stimulation of the shot. These are just some things I have experienced that you might want to discuss with your doctor. My nephrologiest tells me that he and others in his group and seen good improvement in their patients who receive arenesp. I see a hemotologist for the anemia.

    - Betty

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