Diabetic Kidney Disease | Robert Stanton, MD, Joslin Diabetes Center

Diabetic Kidney Disease | Robert Stanton, MD, Joslin Diabetes Center

November 7, 2019 0 By Jose Scott


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.