Kidney is the waste disposal system of our body.The main function of the kidneys is to remove waste from the blood and return the cleaned blood back to the body. But once kidney are damaged ,it is very difficult for them to repair themselves.Kidney failure means the kidneys are no longer able to remove waste and maintain the level of fluid and salts that the body needs.One cause of kidney failure is diabetes mellitus. Over time, the high levels of sugar in the blood damage the millions of tiny filtering units within each kidney. This eventually leads to kidney failure.

Condition and symptoms

Healthy kidneys filter about a half cup of blood every minute, removing wastes and extra water to make urine. The urine flows from the kidneys to the bladder through two thin tubes of muscle called ureters, one on each side of your bladder. Your bladder stores urine. Urine leaves the bladder via the urethra, the thin tube that connects to the outside of the body.
Kidney damage from diabetes is called diabetic nephropathy.Kidneys affected by diabetic nephropathy no longer work efficiently, and trace amounts of protein appear in the urine (microalbuminuria). The retained water and salts cause the characteristic fluid retention and, frequently, the blood pressure begins to rise.
For people with diabetes, kidney problems are usually picked up during a check-up by their doctor. At first, the only sign is high protein levels in the urine, but this has no symptoms. It may be years before the kidneys are damaged severely enough to cause symptoms. Some of the symptoms may include fluid retention (oedema of the legs or face),fatigue.headache,nausea,vomiting.

Diagnosis

Testing may be the only way to know if you have kidney disease. Get checked if you have diabetes, high blood pressure, heart disease, or a family history of kidney failure. The sooner you know you have kidney disease, the sooner you can get treatment.

Diabetic nephropathy is diagnosed using a number of tests including:

• Urine tests – to check protein levels. An abnormally high level of protein in the urine is one of the first signs of diabetic nephropathy.Urine test is done to check for albumin. Albumin is a protein that can pass into the urine when the kidneys are damaged.
• Blood pressure – regular checks for raised blood pressure are necessary. Elevated blood pressure is caused by diabetic nephropathy and also contributes to its progression.
• Blood tests – blood test that checks degree of kidney function, how well your kidneys are filtering your blood called GFR. GFR stands for glomerular filtration rate.
• Biopsy – a small tag of tissue is removed from the kidney, via a slender needle, and examined in a laboratory. This is usually only performed when there is doubt about whether kidney damage is due to diabetes or to another cause.
• Kidney ultrasound – enables the size of the kidneys to be imaged and allows the arteries to the kidneys to be checked for narrowing that can cause decreased kidney function.

Treatment

There is no cure for diabetic nephropathy. Treatment must become ever more aggressive as the kidneys deteriorate towards failure. Medical options include:

• Prevention – this is the best form of treatment and includes good control of blood glucose levels and blood pressure.Important treatments for kidney disease are tight control of blood glucose and blood pressure. Blood pressure has a dramatic effect on the rate at which the disease progresses. Even a mild rise in blood pressure can quickly make kidney disease worsen. Four ways to lower your blood pressure are losing weight, eating less salt, avoiding alcohol and tobacco, and getting regular exercise.
• Diet – some doctors use with macroalbuminuria is a low-protein diet. Protein seems to increase how hard the kidneys must work. A low-protein diet can decrease protein loss in the urine and increase protein levels in the blood. Never start a low-protein diet without talking to your health care team.
• Medications – including medications to reduce high blood pressure, particularly angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers to curb kidney damage.
• Dialysis – or artificial kidney treatment. End stage kidney failure is the failure of the kidney to function at all. Dialysis involves either shunting the patient’s blood through a special machine (haemodialysis) that helps remove the wastes while preserving water and salts, or removing wastes through fluid introduced into the abdomen (peritoneal dialysis). Dialysis is required several times every week for the rest of the person’s life.
• Kidney transplant – a healthy donor kidney, obtained either from someone who has died or from a relative or friend, replaces the function of the diseased kidneys.