What is kidney disease?
Several terms used to describe the various stages of kidney disease, or as it's also called, renal disease.

• The first stage is chronic renal insufficiency, which is the first stage where there is damage to the kidney. This means that there is impaired kidney function, but minimal effects to the entire body.
  
• The second stage is chronic renal failure. This indicates that damage to the kidneys has progressed to a level that causes problems throughout the body. These problems can include a rise in the amount of waste products in the blood such as urea, creatinine and phosphate (all of which are normally removed by the kidneys). This can also include effects such as anemia, bone disease, acidosis, and salt and fluid retention. Most patients with chronic renal failure progress to the final stage called end-stage renal disease.
  
• End-stage renal disease (ESRD) is generally irreversible. Renal replacement therapy (dialysis or a kidney transplant) is needed to sustain life.

What does this have to do with diabetes?

Diabetes mellitus is the main cause of end-stage renal disease. Diabetic renal disease (diabetic nephropathy) represents a long-term complication of diabetes that results from direct vascular abnormalities. One of the first effects on the kidneys for people with diabetes is small quantities of albumin (protein) in the urine (microalbuminuria). Normally albumin is synthesized in the kidney, but larger than normal amounts in the urine indicate an early sign of kidney disease. Susceptible patients eventually develop persistent proteinuria, which presents an increased risk of developing progressive renal disease and ultimately death.

How does cardiovascular disease play a role?

Studies show that cardiovascular disease begins to have an effect on the body as early as the first stage of kidney disease and most people with end-stage renal failure die as a result of cardiovascular complications.

Cardiovascular disease plays such a large role for a several reasons. There are of course traditional risk factors, such as smoking, obesity, hypertension and high blood cholesterol. But kidney disease patients also suffer from other risk factors such as anemia, a disturbed mineral metabolism, high levels of homocysteine and parathyroid hormone excess that contribute to the progression of cardiovascular disease. But many of these risk factors are treatable.

What does this mean for a person with diabetes?

This means the vascular abnormalities accompanying diabetes can produce chronic renal disease that, in turn, increases the risk for CVD. This scenario illustrates the close interaction between the kidney and CVD: Kidney disease can represent either a cause or a consequence of CVD.

What should I do if I have diabetes?

• Keep tight control of your blood sugar and blood pressure. (Keep blood sugars in the normal range; when they are out of range and not controlled, this increases the risk of kidney disease)
• Work closely with your primary healthcare provider to ensure he or she is screening your albumin levels. The American Diabetes Association suggests that screening for albumin levels for those with type 2 diabetes start with the time of diagnosis and follow once every year.

This content is reviewed regularly. Last updated 08/13/08.