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Overview of Diabetic Kidney Disease (videos)

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Q&A | Robert Stanton, M.D., Chief of Nephrology (Kidney Medicine)

Up to 40 percent of people with type 1 diabetes and 20 to 30 percent of those with type 2 diabetes have some form of kidney disease. But much can be done to prevent it or keep it from progressing, says Joslin’s Robert Stanton, M.D., whose Renal Section is devoted to patients with diabetic kidney disease. Here, he answers questions about preventing and treating the disease.

When should someone with diabetes come to the Nephrology Clinic?

You should come if you have diabetes and have signs of kidney disease as discussed below. You may also meet with us to discuss the best approaches to preventing the development of diabetic kidney disease.

There are two tests we recommend be done at least yearly to recognize the presence of the kidney disease as early as possible. It is very important to measure both tests, as abnormal results in either test may indicate kidney disease.

The first is a urine test that reveals an increase of a protein called albumin. An increase in urine albumin (if the increase is relatively low it is called microalbuminuria) is often the first sign of damage to the kidney. This test is best done in a single urine collection where the albumin/creatinine ratio is measured. You should see a kidney doctor if your albumin levels are above 30 mg/g measured on two occasions.

Second is a blood test to measure the level of a chemical called creatinine that is a reflection of kidney filtering. The serum creatinine level is used in a formula to estimate your GFR (glomerular filtration rate). The GFR is the level of filtering at which your kidney is functioning.  At birth GFR is about 120 ml/min and declines at about 1% per year as we age.  Men and women have different GFR levels. 

Thus we use a formula (the MDRD equation) to estimate the kidney’s filtering capacity (GFR) as the MDRD equation accounts for various factors that affect GFR such as age, gender and ethnicity. You should see a kidney doctor if your GFR is less than 60 ml/min. This formula is readily available on-line by using the search term “MDRD Equation” and then entering the requested data.

Why is it so important to catch kidney disease early?

Worsening of kidney disease may be slowed, stopped or even reversed if caught very early. It is very important to slow worsening of kidney as the advanced stage of the disease is kidney failure, when the kidney can’t do its job of filtering harmful wastes from the blood. You can’t live without  at least one functioning kidney. When the kidneys have failed, dialysis or a kidney transplant is necessary to stay alive. Kidney disease can progress more quickly to kidney failure in those with diabetes. The best chance to stop kidney disease from progressing is to recognize it early, when we can start aggressive treatments that can slow or stop the decline in kidney function.

What do you do to help people preserve their kidney health?

We establish an individualized plan for each patient to achieve optimal blood glucose control, optimal blood pressure control, and institute treatments aimed at lowering urine albumin levels. Achieving these three goals has a dramatic effect in slowing progress of the disease. Smoking cessation, nutrition and exercise are also very important parts of maintaining kidney health.

What special expertise does the Joslin Nephrology Clinic offer?

We see and manage people with diabetic kidney disease primarily but we have expertise in all types of kidney diseases. We also do research in all areas of diabetic kidney disease, from basic studies aimed at finding the causes and treatments for diabetic kidney disease to clinical trials with promising new treatments. Thus we are ideally suited to diagnose, treat and do the research needed to give our patients the very best care available.

We have five nephrologists (kidney doctors) and one nurse practitioner all of whom also understand diabetes. We’re all aware of the latest cutting-edge ideas and approaches to diabetic kidney disease because that’s what we think about and read about. We write the chapters on diabetic kidney disease in textbooks, publish journal articles on advances in treatment, and speak and consult around the world. We have been invited to speak all over the United States as well as China, India, Europe, United Arab Emirates, Mexico and South America.

How common is kidney failure and what can be done then?

In general kidney failure occurs in about 10 percent of cases, but it really depends on where someone’s GFR starts at the time of diagnosis. GFR decreases as the disease progresses. If we diagnose and start treating early, when the GFR is in the range of 40 to 60 percent of normal, the chance of the disease progressing is much less than if aggressive management of kidney disease doesn’t start until the GFR is at 25 percent of normal.

Should kidney failure occur, however, we are also on the staff at the Beth Israel Deaconess Medical Center, where dialysis and kidney transplantations are done through our Joslin-BIDMC Transplant Program.

How does someone get a referral to the Nephrology Clinic?

Talk to your doctor for a referral or call directly at 617-309-2477.

Page last updated: April 17, 2014