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    Prevent diabetes problems

    Keep your kidneys healthy

    Number

    3in a

    Series

    of 7

    National Diabetes Information

    Clearinghouse

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    Prevent diabetes problems:Keep your kidneys healthy

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    Contents

    Whatarediabetesproblems?..................................1

    WhatshouldIdoeachdaytostayhealthywithdiabetes?...........................................................2

    Whatdomykidneysdo?..........................................3

    HowcanIpreventdiabetes

    kidneyproblems?.....................................................4 Howcanmydoctorprotectmykidneysduringspecialx-raytests?........................................6

    Howcandiabeteshurtmykidneys?

    WhatcanIdoifIhavekidneyproblems

    .......................7

    causedbydiabetes?..................................................9

    HowwillIknowifmykidneysfail?......................10

    Whathappensifmykidneysfail?.........................11

    WillIknowifIstarttohavekidneyproblems?......13

    HowcanIfindoutifIhavekidneyproblems?...................................................13

    PronunciationGuide...............................................14

    ForMoreInformation...........................................15

    MoreintheSeries..................................................18 Acknowledgments..................................................19

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    What are diabetes problems?

    Toomuchglucoseinthebloodforalongtimecancausediabetesproblems. Thishighbloodglucose,alsocalledbloodsugar,candamagemanypartsofthebody,suchastheheart,bloodvessels,eyes,andkidneys. Heartandbloodvesseldiseasecanleadtoheartattacksandstrokes. Youcandoalottopreventorslowdowndiabetesproblems.

    Ureters

    Kidneys

    Bladder

    Yourkidneysaretwobean-shapedorgansaboutthesizeofyourfist. Theyarelocatedjustbelowthe

    ribcage,nearyourback.

    1

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    What should I do each day to stayhealthy with diabetes?

    Followthehealthyeatingplanthatyouandyourdoctorordietitianhaveworkedout.

    Beactiveatotalof30minutesmost

    days. Askyourdoctorwhatactivitiesarebestforyou.

    Takeyourmedicinesasdirected.

    Checkyourbloodglucoseeveryday.

    Eachtimeyoucheckyourbloodglucose,writethenumberinyourrecordbook.

    Checkyourfeeteverydayforcuts,blisters,sores,swelling,redness,or

    soretoenails.

    Brushandflossyourteetheveryday.

    Controlyourbloodpressureandcholesterol.

    Dontsmoke.

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    What do my kidneys do?

    Thekidneysactasfilterstocleantheblood. Theygetridofwastesandsendalongfilteredfluid.Thetinyfiltersinthekidneysarecalledglomeruli.*

    Whenkidneysarehealthy,thearterybringsbloodandwastesfromthebloodstreamintothekidneys.Theglomerulicleantheblood. Thenwastesand

    extrafluidgooutintotheurinethroughtheureter.Cleanbloodleavesthekidneysandgoesbackintothebloodstreamthroughthevein.

    Glomeruli(tiny filters in

    the kidney)

    Ureter

    (wastes and fluid

    go out in urine)

    Vein(clean blood

    leaves the kidney)

    Artery(blood and wastes

    enter the kidney)

    Youhavetwokidneys.Yourkidneyscleanyourbloodandmakeurine. Thisdrawingshowsacrosssectionofakidney.

    *Seepage14fortipsonhowtosaythewordsinboldtype.

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    How can I prevent diabeteskidney problems? Keepyourbloodglucoseasclosetoyourgoalas

    youcan. Formanypeople,thislevelisasclosetonormalaspossible. Forothers,ahigherbloodglucosegoalmaybebetter. Askyourdoctor

    whatbloodglucosenumbersarehealthyforyou.

    Keepyourbloodpressurebelow140/80tohelppreventkidneydamage. Bloodpressureiswritten

    withtwonumbersseparatedbyaslash. Forexample,120/70issaidas120over70.

    Forsomepeople,ahigherbloodpressuregoal

    maybebetter. Askyourdoctorwhatnumbersarebestforyou. Ifyoutakebloodpressurepillseveryday,takethemasyourdoctortellsyou.Keepingyourbloodpressureundercontrolwillalsoslowdownorpreventdamagetoyoureyes,heart,andbloodvessels.

    Keepyourbloodpressureundergoodcontrol.

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    Askyourdoctorifyoushouldtakepillstoslowdownkidneydamage. Twokindsareavailable:

    ACE(angiotensin-convertingenzyme)inhibitor

    ARB(angiotensinreceptorblocker) Followthehealthyeatingplanyouworkoutwith

    yourdoctorordietitian. Ifyoualreadyhave

    kidneyproblems,yourdietitianmaysuggestyoucutbackonprotein,especiallyanimalproductssuchasmeat,milk,cheese,andeggs.

    Haveyourkidneyscheckedatleastonceayearbyhavingyoururinetestedforprotein. Thistestiscalledtheurinaryalbumintest.

    Haveyourbloodtestedatleastonceayearforcreatinine. Theresultofthistestshouldbeusedtofindyourglomerular ltrationrate(GFR),ameasureofkidneyfunction.

    Pillscanhelpyoucontrolyourbloodpressureandslowdownkidneydamage.

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    Haveanyotherkidneytestsyourdoctorthinksyouneed.

    Avoidtakingpainkillersregularly.Dailyuseofpillslikeaspirinoracetaminophencandamagethekidneys. Takingasingledoseofaspirineverydaytoprotecttheheart,however,shouldbesafe.Takingacetaminophenforoccasionalpainshouldalsobesafe. Butifyouaredealingwithchronic

    pain,suchasarthritis,workwithyourdoctortofindawaytocontrolyourpainwithoutputtingyourkidneysatrisk.

    Seeadoctorrightawayforbladderorkidneyinfections. Youmayhaveaninfectionifyouhavethesesymptoms:

    painorburningwhenyouurinate afrequenturgetogotothebathroom urinethatlookscloudyorreddish feverorashakyfeeling paininyourbackoronyoursidebelowtheribs

    How can my doctor protect mykidneys during special x-ray tests?X-raytestsusingacontrastagentposeariskto

    yourkidneys. Ifyouneedxrays,yourdoctorcangiveyouextrafluidandmedicinebeforeandafterthexraystoprotectyourkidneys. Oryourdoctormaydecidetoorderatestthatdoesnotuseacontrastagent.

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    How can diabetes hurt my kidneys?

    Whenthekidneysareworkingwell,thetinyfiltersinyourkidneys,theglomeruli,keepbloodproteinsinsideyourbody. Youneedtheseproteinstostayhealthy.

    Highbloodglucoseandhighbloodpressuredamagethekidneysfilters. Whenthekidneysare

    damaged,proteinsleakoutofthekidneysintotheurine. Theurinaryalbumintestdetectsthislossofproteinintheurine. Damagedkidneysdonotdoagoodjoboffilteringoutwastesandextrafluid.Wastesandfluidbuildupinyourbloodinsteadofleavingthebodyinurine.

    Kidneydamagebeginslongbeforeyounoticeanysymptoms. Anearlysignofkidneydamageiswhen

    yourkidneysleaksmallamountsofaproteincalledalbuminintotheurine. Buttheonlywaytoknowaboutthisleakageistohaveyoururinetested.

    Withmoredamage,thekidneysleakmoreandmoreprotein. Moreandmorewastesbuildupintheblood. Thisdamagegetsworseuntilthekidneysfail.

    Diabetickidneydisease(DKD)isthemedicaltermforkidneyproblemscausedbydiabetes. DKDaffectsbothkidneysatthesametime.

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    Healthy kidney

    Ureter

    (wastes and fluid)

    Artery

    (blood and wastes)

    Vein

    (clean blood)

    Noalbumin,aprotein,isleakingfromthehealthykidney.

    Unhealthy kidney

    Ureter(wastes, fluid,

    and protein)

    Vein

    (blood with

    waste products)

    Albumin

    Artery

    (blood and wastes)

    Albumin,aprotein,is

    leakingfromtheunhealthykidney.

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    What can I do if I have kidneyproblems caused by diabetes?

    Onceyouhavekidneydamage,youcanslowitdownorstopitfromgettingworsebycontrolling

    yourbloodglucoseandbloodpressure. TakinganACEinhibitororanARBisimportantforbothcontrollingyourbloodpressureandreducing

    kidneydamage. However,ifyouarepregnant,youshouldnottakeanACEinhibitororARB.Ifyouhavediabetes,youshouldhaveyoururineandbloodtestedregularlytoseehowwellyourkidneysareworking. ThetestresultsshouldbegiventoyouasyoururinealbuminandGFRresults.

    Keepingbloodpressureundercontrolhelpstokeepyourkidneyshealthy.

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    How will I know if my kidneys fail?

    Atfirst,youcannottell.Kidneydamagefromdiabeteshappenssoslowlythatyoumaynotfeelsickatallformanyyears. Youwillnotfeelsickevenwhenyourkidneysdoonlyhalfthejobofnormalkidneys. Youmaynotfeelanysignsofkidneyfailureuntilyourkidneyshavealmoststoppedworking. However,gettingyoururineandbloodcheckedeveryyearcantellyouhowwell

    yourkidneysareworking.

    Onceyourkidneysfail,youmayfeelsicktoyourstomachandtiredallthetime. Yourhandsandfeetmayswellfromextrafluidinyourbody.

    Youmayfeelsick

    toyourstomachwhenyourkidneysstopworking.

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    What happens if my kidneys fail?

    Onewaytotreatkidneyfailureiswithdialysis.Dialysisisatreatmentthatdoessomeofthework

    yourkidneysusedtodo. Twotypesofdialysisareavailable(seepage12). Youandyourdoctorwilldecidewhattypewillworkbestforyou.

    Dialysisisatreatmentthattakeswasteproductsandextrafluidoutofyourbody.

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    1. Hemodialysis. Inhemodialysis,yourbloodflowsthroughatubefromyourarmtoa

    machinethatfiltersoutthewasteproductsandextrafluid. Thecleanbloodflowsbacktoyourarm.

    2. Peritonealdialysis. Inperitonealdialysis,yourbellyisfilledwithaspecialfluid. Thefluidcollectswasteproductsandextrawaterfrom

    yourblood. Thenthefluidisdrainedfromyourbellyandthrownaway.

    Anotherwaytotreatkidneyfailureistohaveakidneytranspla