Diabetes Mellitus, either type I or II, is a health condition that affects the necessary kidney function essential for living.
In each kidney there are thousands of tiny microfilters that are responsible for keeping the balance between water, minerals, acids, bases, toxins and nutrients for proper body function. Also, kidneys produce hormones that aid in the production of red blood cells to maintain hemoglobin levels and other substances that keep the bones in optimal conditions.
These microfilters act as strainers where, due to each one’s pores, they retain or filter normal or excessive quantities of red blood cells. The presence of small amounts of a type of protein called albumin in urine can be the start of kidney disease. When diabetes – and arterial hypertension – cause kidney damage, pores are enlarged and permit the passage or large quantities of red cells in urine. Progressively, the microfilters and pores get blocked and are unable to perform their required normal functions.
Due to this blockage of the microfilters, toxic substances can get retained and cause damage to the human body. Also, anemia can develop and bone deterioration could follow. The microfilter’s global functions are known as renal function. There are clinical laboratory tests that can detect if the microfilters are working well. The two tests that are used to evaluate renal function are serum creatinine, that measures the kidney’s function, and albumin found in urine. After getting the results from these tests, the kidney’s filtering capacity can be detected and can show if further treatment may be needed.
It is always recommended to ask your doctor to inform you in which functional stage your kidneys are. An early detection of kidney disease, in most cases, can help avoid deterioration of renal function and the chances of requiring dialysis.
End-Stage Renal Disease (ESRD) is defined as a stage where tissue is destroyed and the kidneys suffer permanent reduced function. At this stage, toxic substances accumulate in the body because they cannot be eliminated by the sick kidneys. The kidneys, in their normal state, produce a hormone known as erythropoietin which is responsible for stimulating the bone marrow to produce red blood cells. In ESRD erythropoietin levels are low, resulting in low hemoglobin levels.
After 30 years of age and as aging progresses, kidney function decreases. Certain medical conditions such as diabetes mellitus, hypertension and abuse of pain relievers can accelerate the loss of kidney function and can eventually pose the need for receiving dialysisor a kidney transplant.
In Puerto Rico the leading cause of ESRD is diabetes mellitus (67.4%) followed by hypertension (12.8%). In our country the majority of the people who begin dialysis are between 60 and 80 years old. It should be clarified that most people who are in this age group will not develop permanent kidney disease and need dialysis.
However, it is important to emphasize that those who are between the ages of 60 and 80 years should be evaluated to determine renal function and whether any albumin or protein is present in urine. Be aware of foam in urine, since this finding may suggest presence of albumin or protein in the urine, a marker of kidney damage and cardiovascular risk.
If we can detect kidney disease, we can also detect in what stage of the disease each person is. More importantly, we may determine if the loss of kidney function is due solely to the aging process of the person and the kidneys.The greatest challenge is working on early prevention or dealing with the disease later. Dr. Rafael Burgos Calderón Medical Director of Atlantis and PR Renal Health & Research, Inc