Leonard Thompson was just an ordinary boy with type 1 diabetes. Looks like a not so spectacular random information, right? Well… Not quite. Leonard Thomson was the first human to receive a shot of insulin. On that day, on January 11th, 1922, a revolution in diabetes management begun. The first shot of insulin was a canine pancreas extract. Twelve days after the first shot, he got another one and then another one and so on… He lived for 13 more years. The extraction of insulin turned the fortunes of the war against the disease that was a death sentence, and humanity started wining it. Instead for a few months, Leonard got 13 more years to live. He died at age 27 of pneumonia.
After introducing insulin into the world of medicine, life expectancy got a lot longer in patients with diabetes. After years of studying diabetes, scientists concluded: The better the glycaemia is controlled, the less complications occur. Less complications means longer lifespan. In fact, if we could achieve the perfect glycaemia control in patients with diabetes, we wouldn’t worry about heart attacks, strokes and other diabetes complications at all. Unfortunately, there is a long way to go before we achieve perfect glycaemia in patients with diabetes. Some people tend to have a bad glycaemia control, although they are extra cautious about their meal plan. One of the complications of the diabetes is a Diabetic Kidney Disease or DKD (also known as diabetic nephropathy in the scientific community).
What happens with kidneys in patients who develop DKD?
Diabetic kidney disease is a condition in which the filtration apparatus of the kidney is damaged, so some of the proteins from a blood stream „leak“ into the urin. The disease is presented without any symptoms in the early stages, while the protein loss is too low to cause any problems for the patient. As the disease progress, the amount of protein that „leaks“ into the urin gets bigger. Albumin molecule is smallest of all protein fractions in the blood, so it leaks first through the kidney filtration system. DKD is divided into two categories, depending on the amount of albumin that’s being lost:
Microalbuminuria (there is less than 300mg of albumin in a 24h urine). Microalbuminuria is the most significant stage of DKD. If recognized on time and treated well, it can go away and DKD can be slowed down, so the disease never develops in the direction of proteinuria. It can be reversed.
Proteinuria (there is more than 300mg of albumin in a 24h urine). Proteinuria suggests that there is a serious kidney function decline. Unlike microalbuminuria, it cannot be reversed. Over time, as the damage of the filtration system develops further, some other, larger, proteins can be detected in urine, such as blood clotting factors. The kidney filtration system becomes so damaged, that a scaring process takes place, leading a patient towards an end-stage kidney failure.
How common is DKD?
In type 1 diabetes quite common, not so common in patients with type 2 diabetes, but there are a lot more patients with type 2 diabetes with DKD (since there are a lot more cases of type 2 diabetes). DKD is the most common cause of the kidney failure in the world. At the time the diabetes is first diagnosed, roughly 12% of patients already has microalbuminuria, and 2% have proteinuria. The reason is, the diabetes is often first time diagnosed after quite some time after the disease had begun.
“I am a diabetic, what can I do to prevent DKD?”
The answer is simple — regular doctor checkups. Urine analysis will reveal any problem with kidney function in the early stages, before its too late.
Have in mind that a DKD is a complication of diabetes. It does not occur in all patients and it does not progress to end-stage kidney failure in those who develop it. The single most important thing you can do is to do your best to control your glycaemia!
Source: https://patient.info/health/diabetic-kidney-disease-l
