Diabetes complications

Kidney disease in diabetes as a comorbidity

Diabetes mellitus is a pathology that has been developing in the body for many years, and sometimes all of life, inevitably causing concomitant health disorders.

Kidney disease in diabetes is one of its complications and requires special therapy under the supervision of the attending physician.

How does diabetes mellitus affect the kidneys?

The kidney is a paired organ, one of the most important in the human excretory system.

Being a "live" filter, they purify the blood and remove harmful biochemical compounds from the body - metabolic products.

Their other function is to regulate the water-salt balance in the body.

In diabetes, the blood contains an abnormally high amount of sugar.

The load on the kidneys increases, because glucose helps to eliminate large amounts of fluid. From this, in the early stages of diabetes, the filtration rate increases and renal pressure rises.

The glomerular structures of the main excretory organ are surrounded by the basement membrane. In diabetes, it thickens, as does the surrounding tissue, which leads to destructive changes in the capillaries and problems with blood purification.

As a result, the work of the kidneys is so disturbed that renal failure develops. It manifests itself:

  • a decrease in the overall tone of the body;
  • headaches;
  • disorders of the digestive system - vomiting, diarrhea;
  • itchy skin;
  • the appearance of metallic taste in the mouth;
  • the smell of urine from the mouth;
  • shortness of breath, which is felt from the minimum physical exertion and does not pass at rest;
  • spasms and cramps in the lower limbs, often occurring in the evenings and at night.
In severe cases, there is a danger of losing consciousness and falling into a coma.

These symptoms do not appear immediately, but more than 15 years after the onset of the pathological processes associated with diabetes. Over time, the blood accumulates nitrogenous compounds that the kidneys can no longer fully filter out. This causes new problems.

Kidney disease in diabetes mellitus (development and / or impact)

Dysfunction of the urinary system in diabetes, developing gradually, can take various forms. In this case, there are serious metabolic disorders. They negatively affect the work of all organs and systems.

Diabetic Nephropathy

Diabetic nephropathy refers to most conditions that are classified as kidney diabetes mellitus.

It is about the defeat of the filtering structures and the vessels that feed them.

This impairment of health is dangerous by the development of progressive renal failure, which threatens to end with a terminal stage - a state of extreme severity.

In such a situation, only dialysis or donor kidney transplantation can be the solution.

Dialysis - extrarenal cleansing of the blood by means of special equipment - is prescribed for various pathologies, but among those in need of this procedure, the majority are patients with type II diabetes.

As already mentioned, the defeat of a pair of major urinary organs in people with a "sugar" problem develops over the years, without particularly manifesting itself at the very beginning.

The renal dysfunction formed in the first stages, while progressing, goes into a deeper stage, which is diabetic nephropathy. Its course of medical specialists is divided into several stages:

  • the development of hyperfiltration processes leading to increased blood flow and, as a consequence, an increase in the size of the kidneys;
  • a slight increase in the amount of albumin in the urine (microalbuminuria);
  • a progressive increase in the concentration of albumin protein in urine (macroalbuminuria), occurring against the background of an increase in blood pressure;
  • the appearance of nephrotic syndrome, indicating a significant decrease in glomerular filtration functions.
The final stage is the development of severe renal failure.

Pyelonephritis

Pyelonephritis is a non-specific inflammatory process in the kidneys, which has a bacterial origin and affects the structures of the main urinary organ.

A similar condition may exist as a separate pathology, but more often it is a consequence of other health disorders, such as:

  • urolithiasis disease;
  • infectious lesions of the reproductive organs;
  • diabetes.

As for the latter, it causes pyelonephritis very often. At the same time, the inflammation of the kidneys is chronic.

To understand the causes, it is important to understand that, regardless of the infectious nature of the pathology, there is no specific pathogen.. Most often, inflammation occurs due to exposure to coccal microorganisms and fungi.

The situation is complicated by the fact that the course of diabetes mellitus is accompanied by a weakened immune system.

Glucose, contained in the urine, creates an ideal nutrient medium for pathogenic microorganisms.

The protective structures of the body can not fully perform their functions, therefore, pyelonephritis develops.

Microorganisms affect the kidney filtration system, leading to the formation of bacterial blood clots, surrounded by leukocyte infiltrate.

The development of pyelonephritis for a long time can occur sluggishly and asymptomatically, but then inevitably there is a worsening of the condition and well-being:

  • urinary function suffers. The daily amount of urine decreases, problems with urination appear;
  • a person complains of pains of a whining character in the lumbar region. They can be unilateral or bilateral, arising regardless of the factors of movement and physical activity.
It is noteworthy that the pain does not develop into renal colic and do not give to other parts of the body. The accompanying symptoms may be increased blood pressure and an increase in body temperature to subfebrile values.

Stones in the kidneys

The formation of kidney stones occurs for various reasons, but somehow it is always associated with metabolic disorders.

The formation of oxalates becomes possible from the combination of oxalic acid and calcium.

Such structures are combined into dense plaques with a rough surface that can injure the epithelium of the inner surface of the kidneys.

Kidney stones are not uncommon in people with diabetes. The culprit is destructive processes in the body and, in particular, in the kidneys. Pathology disrupts blood circulation, making it insufficient. Trophic nutrition of tissues worsens. As a result, the kidneys are deficient in fluid, which activates the function of absorption. This leads to the formation of oxalate plaques.

The hormone aldosterone, synthesized in the adrenal glands and necessary for regulating the level of potassium and calcium in the body, does not have the desired effect. Because of the reduced susceptibility to it, salts accumulate in the kidneys. A condition that doctors call urolithiasis develops.

Cystitis in diabetes

Cystitis - a phenomenon, alas, common.

To many, he is known as an infectious bladder inflammation.

However, few people know that the risk factor for this pathology is diabetes mellitus.

This circumstance is due to:

  • atherosclerotic lesions of large and small vessels;
  • disruptions in the immune system, which significantly reduce the protective capabilities of the bladder mucosa. The body becomes vulnerable to exposure to disease-causing flora.

The appearance of cystitis is impossible not to notice. He makes himself known:

  • problems with urine excretion. The process becomes difficult and painful;
  • pains in the lower abdomen, resembling contractions. The greatest suffering they cause when trying to urinate;
  • blood in urine;
  • signs of intoxication, one of which is an increase in body temperature against the background of general malaise.
In the absence of medical interventions, the condition progresses rapidly, "overgrown" with complications, and may require hospitalization.

Treatment

A feature of the treatment of disorders of the urinary system in diabetes mellitus is that it should be combined with a set of measures for the main pathology.

This means that the choice of drugs and their dosage must be agreed with your doctor.

So, when detecting nephropathy, the tactics of treating diabetes change. There is a need to cancel certain drugs or reduce their dosage.

If the filtration function is noticeably affected, the insulin dose is adjusted downwards. This is due to the fact that the weakened kidneys are not able to remove it from the body in a timely manner and in the right amount.

Therapy for bladder inflammation (cystitis) in diabetes mellitus includes:

  • receiving furadonin four times a day, every 6 hours. Alternatively, trimethoprim (twice daily, at equal intervals) or cotrimoxazole may be given;
  • administration of antibacterial drugs (Doxycycline or Amoxicillin) for a period of three days to one and a half weeks, depending on the form and severity of the pathology;
  • receiving antispasmodic drugs.

An important condition is an enhanced drinking regime during the period of taking medications, as well as strict implementation of personal hygiene measures.

Therapy of urolithiasis presents certain difficulties. This is due to the fact that in most cases the mineral formation in the kidneys cannot be dissolved or destroyed by medication.

Small stones can sometimes be brought out naturally, and large ones are better operative. So doctors advise. This is especially true when the ultrasound examination shows that oxalate is of impressive size and represents a real threat to life if it moves and closes the duct.

Modern medicine has the latest methods of operations to remove kidney stones.

One of these is a way to destroy education directly in the cavity of the excretory organ.

At the same time, skin injury is minimal, and the recovery period is much shorter than with conventional surgery.

Hospital stay is limited to 2-3 days, and the main measure of prevention of relapse will be compliance with the rules of nutrition established by the doctor.

So, problems with the urinary system in diabetes, unfortunately, are inevitable. However, this does not mean that they can not be fought. Careful attention to your own health, timely access to a doctor and implementation of his recommendations will help relieve unpleasant symptoms, stabilize the condition and avoid more serious complications.

Video on the topic

Watch the video: Comorbid Kidney Disease and Diabetes Dramatically Increase Risk of Cardiovascular Disease (September 2019).