Diabetes is the leading cause of kidney failure. According to the 2009 Annual Data Report of the United States Renal Data System, 197,037 of the 527,283 U.S. residents under treatment, or slightly more than 37 percent, needed treatment because of diabetes. Like other patients with chronic kidney disease, the first symptom of kidney involvement is high urine protein.
Mechanism
In healthy people, the kidneys prevent protein in the blood from spilling into the urine. In people with kidney disease, including diabetic kidney disease, the kidneys are less able to perform this important function. The mechanism of this is not entirely clear, but some researchers believe that the membrane of the glomerulus, or kidney filter, becomes more porous to proteins. This is consistent with research findings that appeared in the June 2011 issue of "Kidney International."
Treatment
Proteins are large complex molecules and they can damage fragile glomeruli when they pass through the filters. Consequently, nephrologists try to control this problem to prevent further damage. Angiotensin converting enzyme inhibitors, better known as ACE inhibitors, are often the first approach in treating this condition because they lower blood pressure in the glomeruli. If urine protein is very high, nephrologists may try prednisone or another type of immunosuppressant.
Diet
The National Kidney Foundation recommends that diabetics with kidney disease whose glomerular filtration rate, or GFR, is greater than 15 ml/min/m2 should limit protein consumption to 0.8 g/kg body weight per day. Patients who have a GFR less than 15 and who are not yet on dialysis should limit daily protein intake to about 0.60 g/kg. Kidney patients on dialysis should eat as much protein as possible because dialysis removes important amino acids from the blood.
Warning
Many factors go into recommending a particular diet for diabetic kidney patients, so you should not change your diet without asking your nephrologist how much protein she thinks you should be consuming. Your age, well-being, symptoms and laboratory results all factor into dietary recommendations. Working with a renal dietitian can be very helpful in designing healthy meals that satisfy your nephrologist's recommendations.
Warning
Diabetics and other kidney patients should ask their nephrologists how much dietary protein they should consume.
References
- "Kidney International"; The Glomerular Endothelial Cell Coat is Essential for Glomerular Filtration. V. Fridén; 2011 June 2011
- National Institute of Diabetes and Digestive and Kidney Disease; Kidney and Urologic Diseases Statistics for the United States; April 2010
- National Kidney Foundation: Glomerular Filtration Rate (GFR)
- Problem-Oriented Diagnosis Proteinuria in Adults: A Diagnostic Approach; Michael F. Carroll, et al.; Sept. 2000
- National Kidney Foundation: KDOQI Guideline 5
