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The effect of diabetes on the kidneys and bladder

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In a recent article, I looked at the causes of most diabetic complications.{{more}} These complications are considered chronic and are the ones most commonly seen in diabetics who have been on treatment for years. Diabetes can affect any organ in the body, because all organs have nerves and blood supply which are directly affected by diabetes. Some of these organs include the heart, the brain, the kidneys, the eyes, the limbs, the blood and the stomach and bowel.

I cannot go into the details of all the complications in this article; however I will discuss the main one. In my last article on diabetes, I outlined how damage to the blood vessels and nerves affect the lower limbs and cause gangrene and loss of the limbs. This week I’ll look at the effects of diabetes on the kidneys and the bladder.

The kidneys are affected mainly via the blood vessels in the organ. In the early stages, the patient has no problems, but the sugar poorly controlled. This causes an increase of blood to the kidney as the body tries to “wash out” the sugar. The kidney is hyperperfused or is getting too much blood or is overworking. The overworking causes leakage of protein in the urine. The doctor may notice traces of protein in the urine and if he does not, he should test for it in the lab. Protein in the urine (called proteinuria) is an early sign that diabetes is affecting the kidneys. Diabetes affects the kidneys more if the sugar is poorly controlled or you have high blood pressure or you have a single kidney. Over a period of time, if the sugar is not properly controlled, the protein in the urine gets worse as the disease progresses. The strainer mechanism of the kidney starts getting “blocked up” by the protein and the body starts destroying these “blocked” units. Eventually the kidney shrivels and dies. At this stage, the person has chronic renal failure (end stage renal disease or ESRD) and needs dialysis. The time between the development of protein in the urine and ESRD is 5-10 years. That means the development of protein in the urine is an early sign of diabetic kidney disease. Diabetics also “pick up” kidney infection. Repeated infections can cause scarring of the kidney and high blood pressure. The usual cause of the kidney infections is via bladder infections, as will be outlined below. Recurrent kidney infections can be prevented by proper sugar control.

Diabetics also pick up bladder infections because, as the diabetes progresses, poorly controlled, the nerves to the bladder are damaged. This means the bladder does not empty properly and the “retained” urine, which also has a lot of sugar, creates a perfect place for bacteria to grow. This causes bladder infections. The kidneys then get infection from the bladder. Diabetics who get bad or recurrent bladder and kidney infections tend to develop blood in the urine called hematuria. All the above kidney and bladder problems can be alleviated by diabetics making sure that their sugar is well controlled. Actually, if we see a diabetic with early kidney disease, we can reduce the rate of decline or even reverse some changes by proper diabetes control and the use of medications called ACEI or ARBs. Next week, I will continue to explore how diabetes affects the heart, blood and blood vessels.

For comments or question contact:
Dr Rohan Deshong
Tel: (784) 456-2785
Email:deshong@vincysurf.com

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