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February 20, 2007 > Diabetes Matters:

Diabetes Matters:

Kidney Health & Diabetes

Healthy kidneys are vital to your body's proper functioning. These bean-shaped organs, which are about the size of a fist, are located near the middle of the back, just below the rib cage. The kidneys cleanse your blood of extra water and waste products from the food you eat and the normal breakdown of other body tissues. If the kidneys did not remove these toxins, they would build up in the blood and damage the body.

"Kidneys are as important to the body as the heart," says Washington Hospital nephrologist Dr. Lucia Yumena. "Your kidneys are not just 'filters' for waste products. They also are like 'chemical factories' that release important hormones that stimulate production of red blood cells and regulate blood pressure. Kidney hormones also help maintain calcium for the bones and balance the body's levels of water, electrolytes and minerals."

Unfortunately, according to the U.S. Centers for Disease Control and Prevention, nearly 8 million Americans have moderate to severe chronic kidney disease, and more than 450,000 are undergoing treatment for end-stage renal disease. The most common cause? Diabetes.

"Approximately 100,000 people in the U.S. have kidney failure every year, and diabetes counts for nearly half of all new cases," says Washington Hospital Director of Diabetes Services Theresa Garnero, APRN, BC-ADM, MSN, CDE.

"Diabetes is a disease in which the body does not make enough insulin or cannot use insulin properly to regulate the amount of sugar in your blood," Garnero explains. "When blood has a higher sugar content, it is thicker - or more viscous - and it is harder for the blood to flow through the tiny blood vessels in the kidneys where it is filtered. Over time, high levels of blood sugar can lead to permanent kidney injury and even death."

To help people in the community learn more about this serious problem, Washington Hospital will be sponsoring a free "Diabetes Matters" education class on kidney health and diabetes, featuring a lecture by Yumena and a group discussion moderated by Garnero. Yumena is a physician specializing in kidney function and disease. Garnero is an advance practice registered nurse, a board certified-advanced diabetes management clinical specialist and a certified diabetes educator. The session is scheduled for Thursday, March 1 from 7 to 9 p.m. in the Conrad E. Anderson, M.D. Auditorium in the Washington West Building located at 2500 Mowry Avenue in Fremont.

"People with diabetes need to be aware of their risk for kidney disease," Yumena notes. "In the early stages of kidney disease, you may not know you have a problem. Symptoms often don't arise until you've lost 50 percent of your kidney function. Fortunately, kidney disease is preventable. And if you do develop kidney disease, its progress can be slowed down. The key is early detection."

A simple urine test is the best way to detect early stage kidney disease, Garnero says. "We screen the urine for the proteins microalbumin and creatinine. High levels of these proteins in the urine can be an early sign of diabetic kidney disease, long before symptoms become apparent. People should have this test performed every year. Even children with diabetes should have this urine test."

As kidney disease progresses, physical symptoms may develop, including:
* Swelling of the ankles and legs
* Discolored or dark urine
* Frequent urination at night
* Dry, itchy skin

"For people with diabetes, it's important to focus on prevention of kidney disease," Yumena says. "This means controlling your blood sugar levels as well as your blood pressure. Eat a healthy diet. Avoid alcohol. Get plenty of exercise. Quit smoking. Watch your cholesterol levels."

For people who are diagnosed with kidney disease, physicians may recommend treatment with blood pressure medications that also have protective qualities for the kidneys: angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs).

"ACE inhibitors and ARBs can halt the progress of kidney disease and prevent kidney failure," Yumena says. "Patients whose kidney disease has progressed to kidney failure or 'end stage' disease require dialysis - running their blood through a machine to filter out the toxins - or a kidney transplant.

"To avoid such drastic measures, people need to be proactive with their doctors and seek the tests they need," she adds. "A simple, painless urine test can make all the difference."

"Diabetes Matters" is a monthly program sponsored by Washington Hospital that provides science-based information to people interested in increasing their knowledge about diabetes. The classes, held the first Thursday of every month except July, are free and require no pre-registration. All of the lectures are videotaped and available in the Community Health Resource Library, as well as on the Washington Hospital Web site. Go to, click on the "Services and Programs" tab, and then click the link for "Diabetes Services," then "Diabetes Matters." For more information, call (510) 608-1327.

The "Diabetes Matters" lectures also will be airing on Washington Hospital's InHealth Channel. To check broadcast schedules, go to,
click on "For Our Community" and select "The InHealth Channel" from the drop down menu.





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