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Diabetic Kidney Disease: A Key to Earlier Diagnosis

As you stare down those sweets and calories at the Thanksgiving table, you may need to consider being screened for diabetes and diabetic kidney disease. It has been estimated that one-third of diabetics are undiagnosed.
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The month of November kicks off the holiday season and includes a Thanksgiving feast filled with sweets and calories galore. November also happens to be National Diabetes Awareness Month. Coincidence or not, it's important to remember that diabetes is a major risk factor for kidney disease. Diabetes is responsible for more than 40 percent of patients on kidney dialysis today.

However, even among this high-risk group, there are a percentage of diabetics who have progressive kidney disease without the tell-tale signs of kidney damage in their urine. The good news is that this group of people may have something to be thankful for, a new test which could catch kidney disease before it does irreversible damage.

A recent report in the New England Journal of Medicine has suggested a new way to diagnose diabetic kidney disease before significant deterioration in kidney function occurs. This report used a blood test to measure a protein in the blood known as soluble urokinase-type plasminogen activator receptor, thankfully shortened to suPAR. This protein is found in certain cells of the kidney. If the blood test reveals elevated levels, there have been studies to suggest that there is inflammation in the kidney that has been correlated with onset and progression of kidney disease. In this particular study, patients at risk for heart disease, including diabetics, were screened for elevated blood levels of suPAR. In patients with normal kidney function, an elevated test result was associated with a two- to three-fold increase in the risk of developing kidney disease. An elevated test result was also associated with a more rapid deterioration in kidney function over the duration of the study by more than four fold.

In patients with diabetes, we commonly use protein in the urine (proteinuria) as a marker to diagnosis kidney disease. In this report, this association was present with or without protein in the urine. Hence, this could be the way to forecast which patients with diabetes should be treated early and aggressively for diabetic kidney disease.

It has been shown that treatment of early diabetic kidney disease with high blood pressure medications such as ACE-inhibitors or ARB agents can slow the progression regardless of whether the patient has high blood pressure or not. Blood pressure control with these agents is a cornerstone of treatment. Blood pressure should be controlled to less than 130/80. Diabetics should take cholesterol lowering drugs (such as statins) to prevent complications of heart disease and also to slow the progression of kidney disease. Increasing physical activity and eating a healthy low salt diet that encourages maintenance of a healthy body weight will also contribute to control of diabetes and slowing the progression of diabetic kidney disease.

As you stare down those sweets and calories at the Thanksgiving table, you may need to consider being screened for diabetes and diabetic kidney disease. It has been estimated that one-third of diabetics are undiagnosed. If you have a family history of diabetes or if you have gained significant amounts of weight, you may need to consider being screened. Other risk factors include obesity (particularly abdominal obesity), non-white ethnicity (especially Asian, American Indian and Hispanic), smoking, and lack of regular exercise.

For more information, watch this video on protecting your kidneys during National Diabetes Awareness Month.

You can learn more about diabetes and kidney disease by visiting the National Kidney Foundation.