The Kidney Connection

Gil Grimes, MD

June 22, 2007

The Kidney

The Kidney

The Kidney

The Kidney

Function

• The kidneys are powerful chemical factories that perform the following functions:– remove waste products from the body – remove drugs form the body – balance the body's fluids – release hormones that regulate blood pressure – produce an active form of vitamin D that promotes

strong, healthy bones – control the production of red blood cells

How does it do that?

• Each kidney contains up to a million functioning units called nephrons.

• A nephron consists of a filtering unit of tiny blood vessels called a glomerulus attached to a tubule.

How does it do that?

• When blood enters the glomerulus, it is filtered and the remaining fluid then passes along the tubule.

• In the tubule, chemicals and water are either added to or removed from this filtered fluid according to the body's needs, the final product being the urine we excrete.

Kidney Facts

• The kidneys perform their life-sustaining job of filtering and returning to the bloodstream about 200 quarts of fluid every 24 hours.

• Two quarts are removed from the body in the form of urine, and about 198 quarts are recovered.

What does Diabetes do?

• With diabetes, the small blood vessels in the body are injured.

• When the blood vessels in the kidneys are injured, your kidneys cannot clean your blood properly.

• Your body will retain more water and salt than it should, which can result in weight gain and ankle swelling.

• You may have protein in your urine.

What does Diabetes do?

• Diabetes also may cause damage to nerves in your body.

• This can cause difficulty in emptying your bladder.

• The pressure resulting from your full bladder can back up and injure the kidneys.

• If urine remains in your bladder for a long time, you can develop an infection from the rapid growth of bacteria in urine that has a high sugar level.

What are some signs of damage?

• Albumin/protein in the urine • High blood pressure • Ankle and leg swelling, leg cramps • Going to the bathroom more often at night • High levels of BUN and creatinine in blood • Less need for insulin or antidiabetic

medications • Morning sickness, nausea and vomiting • Weakness, paleness and anemia • Itching

How is it diagnosed?

• Blood testing yearly– The glomerular filtration rate– Blood Urea Nitrogen level (BUN)– Creatinine level

• Urine testing yearly– Microalbumin test

• Regular blood pressure checks

How is it prevented?

• Control your diabetes

• Control high blood pressure

• Get treatment for urinary tract infections

• Correct any problems in your urinary system

• Avoid any medicines that may damage the kidneys (especially over-the-counter pain medications like motrin, aleve, naprosyn)

How do I minimize the damage?

• Seeing a nephrologist, the kidney doctor– Together they will plan your treatment with

you and you family, your family physician and your dietitian.

• Control your diabetes

How do I minimize the damage?

• Controlling high blood pressure in conjunction with an ACE inhibitor

• Following your renal diabetic diet. – Restricting protein in your diet also might be

helpful. – You and your dietitian can plan your diet

together.

Questions?