Chronic Kidney Disease Chapter 10

Diabetes and Hypertension: Causes of CKD


Diabetes and CKD

Diabetes and CKD are intimately related. In fact, diabetes is the number one cause of CKD and is responsible for 60% of the cases of CKD that eventually result in kidney failure. Type 2 diabetes is responsible for more than one out of three new cases, and almost 40% of new dialysis patients have diabetes. READ MORE

When you have diabetes, there’s too much glucose (blood sugar) in your blood because your body can’t make enough insulin or because it can’t use insulin properly anymore. High levels of glucose are toxic to the tiny, fragile capillaries in the kidneys’ glomeruli. The glomeruli are tiny tufts of capillaries that are essential to the functioning of the nephrons, the main filtering units of the kidney. Holes form in the capillary walls and the glomeruli lose their ability to filter blood.

When this happens, proteins in the blood that should stay in the bloodstream instead leak across the diseased capillary walls into the waste stream. Doctors can diagnose kidney damage by measuring excess levels of protein in the person’s urine, a condition called proteinuria. LESS


Insulin and Diabetes

Insulin is a hormone, produced by the pancreas, which lowers the level of glucose in the blood. It’s released into the bloodstream when a person’s glucose level goes up, for instance after eating. Insulin assists in the utilization of glucose by the body’s fat and muscle cells, where it can be used for energy or stored for future use. In diabetes, the pancreas doesn't produce enough insulin or the body can't respond normally to the insulin that is produced. This causes the glucose level in the blood to rise.


Hypertension and CKD

Small Blood Vessels
The main function of your arterioles and capillaries, the smallest blood vessels in your body, is to supply oxygen and nutrients to the tissues of organs throughout your body. No organ in your body is more densely packed with capillaries than your kidneys. High blood pressure can damage and even destroy these tiny, vulnerable vessels, causing a reduction in both their number and their function. When this happens, connective tissue overtakes the normal tissue that surrounds the healthy glomeruli. Eventually the glomerular capillaries wrinkle, shrink, and harden, obstructing blood flow and leaving the glomerulus unable to function. READ MORE

Larger Blood Vessels
Because your kidneys are constantly filtering your blood, they require a substantial blood supply. This is brought to them by large arteries called the renal arteries. High blood pressure can damage the renal arteries as well as other arteries throughout your body. Chronic high pressure on artery walls causes them to expand, then break, scar and rebuild, causing reduction in blood vessel diameter and further increasing blood pressure. Your arteries become stiff and rigid and are unable to contract and dilate in order to control blood flow. Blood flow to the kidneys becomes reduced or even blocked, damaging the delicate kidney tissue and reducing kidney function. LESS

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