Kidney Disease

Primary diagnoses • Two types of diabetes • The course of kidney disease • Effects of high blood pressure • Preventing and slowing kidney disease • Good care makes a difference • Looking to the future

Each year in the United States, more than 50,000 people are diagnosed with end-stage renal disease (ESRD), a serious condition in which the kidneys fail to rid the body of wastes. ESRD is the final stage of a slow deterioration of the kidneys, a process known as nephropathy.

The diagnoses of kidney disease are caused:

Diabetes is the most common cause of ESRD, resulting in about one-third of new ESRD cases. Even when drugs and diet are able to control diabetes, the disease can lead to nephropathy and ESRD.

Most people with diabetes do not develop nephropathy that is severe enough to cause ESRD. About 15 million people in the United States have diabetes, and about 50,000 people have ESRD as a result of diabetes.

ESRD patients undergo either dialysis, which substitutes for some of the filtering functions of the kidneys, or transplantation to receive a healthy donor kidney. Most U.S. citizens who develop ESRD are eligible for federally funded care. In 1994, the Federal Government spent about $9.3 billion on care for patients with ESRD.

African Americans and Native Americans develop diabetes, nephropathy, and ESRD at rates higher than average. Scientists have not been able to explain these higher rates. Nor can they explain fully the interplay of factors leading to diabetic nephropathy--factors including heredity, diet, and other medical conditions, such as high blood pressure. They have found that high blood pressure and high levels of blood sugar increase the risk that a person with diabetes will progress to ESRD.

In diabetes--also called diabetes mellitus, or DM--the body does not properly process and use certain foods, especially carbohydrates.

The human body normally converts carbohydrates to glucose, the simple sugar that is the main source of energy for the body's cells. To enter cells, glucose needs the help of insulin, a hormone produced by the pancreas.

When a person does not make enough insulin, or the body is unable to use the insulin that is present, the body cannot process glucose, and it builds up in the bloodstream. High levels of glucose in the blood or urine lead to a diagnosis of diabetes.

NIDDM

Most people with diabetes have a form known as noninsulin-dependent diabetes (NIDDM), or Type II diabetes.

Many people with NIDDM do not respond normally to their own or to injected insulin--a condition called insulin resistance. NIDDM occurs more often in people over the age of 40, and many people with NIDDM are overweight. Many also are not aware that they have the disease.

Some people with NIDDM control their blood sugar with diet and an exercise program leading to weight loss. Others must take pills that stimulate production of insulin; still others require injections of insulin.

IDDM

A less common form of diabetes, known as insulin-dependent diabetes (IDDM), or Type I diabetes, tends to occur in young adults and children.

In cases of IDDM, the body produces little or no insulin. People with IDDM must receive daily insulin injections.

NIDDM accounts for about 95 percent of all cases of diabetes; IDDM accounts for about 5 percent. Both types of diabetes can lead to kidney disease. IDDM is more likely to lead to ESRD. About 40 percent of people with IDDM develop severe kidney disease and ESRD by the age of 50. Some develop ESRD before the age of 30. NIDDM causes 80 percent of the ESRD in African Americans and Native Americans.

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