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Article by Carolien Koreneff, CDE, Diabetes NSW & ACT.
Diabetes is the leading cause of kidney disease in Australia. According to a report by the Australian Institute of Health and Welfare, about 1 out of 4 adults with diabetes has Diabetic Nephropathy, or diabetes kidney disease, and diabetic nephropathy was the leading cause of treated ESKD, accounting for 37% of new cases in 20141. End Stage Kidney Disease (ESKD) attributed to diabetic nephropathy has steadily increased over the past 15 years.
The main job of the kidneys is to filter and remove wastes and extra water out of the blood, by making urine. The kidneys also help control blood pressure. When the nephrons in the kidneys are damaged, they can’t filter blood like they should, which can cause wastes to build up in the body.
Kidney damage caused by diabetes usually occurs slowly, over many years. Although one can take steps to protect the kidneys and to prevent or delay kidney damage, kidney disease is often called a ‘silent disease’, as up to 90% of kidney function can be lost before symptoms appear. As a result, many people are unaware that they have the condition1,2.
Types of nephropathy
We refer to ‘Acute kidney injury’ (AKI) if the kidneys recover normal function within three months. AKI is usually caused by injury or trauma to the kidney which restricts the blood supply or due to severe inflammation.
‘Chronic kidney disease’ is where there is a loss of healthy kidney function for more than three months. Chronic kidney disease is the most common form of kidney disease; there are five recognised stages.
Another term often used when talking about nephropathy is End Stage Kidney Disease (ESKD); this is the most severe form of kidney disease, where people usually require dialysis or a kidney transplant to survive.
How does diabetes cause kidney disease?
Hyperglycaemia (high blood glucose levels), as well as hypertension (high blood pressure) – a common complication of diabetes, can damage the capillary blood vessels in the nephron and thereby cause nephropathy. Other risk factors include: smoking, high salt (sodium) intake, inactivity, being overweight or obese, heart disease, having a history of renal calculi and family history of kidney failure. As many of these risk factors are modifiable CKD is largely preventable. Kidney disease is not reversible, but it is treatable if caught early.
Image 1 shows data which highlights the number of people in Australia who are at risk of kidney disease (bottom tear) and those with CKD in its various stages3. It is estimated that 1 in 9 Australians have CKD.
A new system for staging CKD was introduced to Australia in 20124. This new system factors in albuminuria, has a better correlation with progression and resulted in quantification of risk for both CKD progression and cardiovascular events. The following image highlights the stages of CKD:
How do we detect CKD?
There are 3 areas of focus in regards to CKD detection2,3,4:
For more information on kidney disease we recommend the following resources: