About 30 to 40 percent of people who have type 1 diabetes will have kidney disease.
About 20 to 30 percent of people with type 2 diabetes will have kidney disease. Not all
of them will progress to kidney failure, meaning requiring dialysis or transplantation which
is everybody's biggest fear when they come see me. But some will and it's very important
to diagnose these people early and to treat them early.
When you develop kidney disease
and it worsens not only do the kidney functions get worse, but almost every other aspect of
diabetes gets worse. Kidney disease seems to be that tipping point when the cardiovascular
system, eyes, and other issues all start worsening at a more rapid rate. Early diagnosis of kidney
disease early aggressive management actually has a huge effect on protecting the rest of
your body from the side effects of diabetes. There are three main areas we approach to
help slow progression of kidney disease. The first area is blood sugar control, so we work
closely with the Joslin diabetologists or any of the other physicians you might be working
with to get the appropriate level of blood sugar control that will have a dramatic effect
on slowing progression of any complications of diabetes. Number two is blood pressure
control, maybe the most important aspect of protecting kidneys from damages, getting the
blood pressure to as low as possible for you that makes sense that you don't have side
effects from it, but also protects kidney function. That's a complicated procedure nowadays
because it requires multiple medications. At Joslin we're very familiar with using all
these medication to make them work properly and to limit the side effects from all of
these. Number three is another aspect of kidney disease, development of protein in the urine.
If you have protein in the urine that can lead to worsening kidney function.The way
we approach that is using particular medications in addition to the blood pressure and blood
sugar control that target urine production control. Together, taking all these various
approaches as well as some others that may also slow progression of kidney disease, we're
able to dramatically reduce the likelihood of you ending up on dialysis or transplant.
We focus primarily on people with diabetes. 90 percent of our patients have diabetes and
kidney disease. We're comprised of 5 nephrologists and one nurse practitioner, whose combined
experiences adds up to over 100 years worth of patient care. We have seen all the complications
associated with diabetes and kidney disease, we've seen all the unusual diagnoses and other
conditions, we know how the medications work in patients with diabetes, so we bring all
this unique expertise to the situation and we can best manage that because we've seen
all this. Moreover, we work very closely with the adult diabetologists, with exercise physiologists,
with nutritionists, as a group to provide you with the best education, as well as the
best care plan that you can have to take care of your kidneys.
There are no symptoms that you'll have
that will tell you that it is necessary to see a Joslin nephrologists. This
can only be done by lab tests, and when you develop symptoms from kidney problems, your
kidney disease is very far gone, so you do not want to wait till that time period. So
there's a blood test and there's a urine test that is primarily used. The blood test is
called the serum creatinine-
c r e a t i n i n e
-and that is a reflection of your kidney
function and that test is then put into a formula called the GFR formula. That gives
you an assessment of where your kidney function is. The other is the urine test, which measure
the amount of protien in the urine and that, if elevated, is a sign of kidney damage . If
you have diabetes and you have decreased GFR and/or increased urine protein then you should
see a kidney doctor.