Diabetes is a disease of glucose (sugar) metabolism which is characterized by the inability to use glucose. Diabetic individuals cannot utilize glucose once it has been produced by the digestion of food or by the liver, so excess glucose accumulates in the body. It is this accumulation of glucose that is responsible for a number of the consequences of untreated diabetes. One of the most common sites for damage due to uncontrolled diabetes is in the kidney. There are stages of kidney disease (nephropathy) associated with diabetes and each has associated complications. The severity of the complications closely follows the severity of the nephropathy..
The first stage of kidney disease is called microalbuminuria, which means “small amounts of protein in the urine”. Simply put, the kidneys are filters for the blood. They are designed to keep useful molecules in the blood while filtering-out the waste products of the body’s cellular metabolism, drugs, and other toxic substances that may get into the blood stream. The filtered substances are passed out of the body in the urine. In poorly controlled diabetics, the filtering system gets damaged over time. The first detectable sign of this is that the kidneys leak protein out of the blood into the urine. According to the American Diabetic Association website, if detected at this stage, the kidney disease is reversible. There are no significant side effects of microalbuminuria, except that the loss of proteins and extra sugars will draw more out of the blood and into the urine – so the individual feels thirsty.
If the progression of the disease continues, the kidney’s filters are more severely damaged and large amounts of protein begin to be lost from the blood into the urine. Under normal circumstances there are balanced oncotic pressure gradients in the body. This means that between different compartments of the body (mainly between blood and the tissues) there is a concentration difference in larger protein molecules. According to the laws of chemistry and biochemistry, water tends to be drawn from compartments of lower concentration into compartments of higher concentration in order to equalize the concentrations in both compartments. Thus, when the blood loses protein to the urine, the concentration of protein in the blood drops relative to the concentration of proteins in the tissues. As outlined above, the consequence of this is that fluid (water) leaks out of the blood vessels into the surrounding tissues to try to balance the concentrations. This is commonly seen as edema. As noted in an article from the National Institutes of Health, once stage is reached, the process usually continues to End Stage Kidney Failure.
End Stage Kidney Disease
End stage kidney disease or End Stage Renal Disease (ESRD) is diagnosed when the kidneys no longer function adequately for an individual to live normally. It is usually a consequence of long-standing kidney disease, either from diabetes or from other causes. Individuals with end stage kidney disease display a variety of symptoms resulting from the inability of the kidneys to filter the blood and the accumulation of toxic substances. As described on the University of Virginia Health System website, symptoms may include: fatigue, generalized itching, headaches, weight loss, vomiting, skin color changes, drowsiness, insomnia, confusion, coma and even death. Individuals who are at this stage of the disease process require regular dialysis treatments or a kidney transplant in order to survive.