Bladder and kidneys Damage of the bladder and kidneys is a complication of diabetes. People with diabetes are at risk of bladder and kidney infections, kidney failure, and dialysis Good diabetes self-management and keeping your blood pressure at a healthy level will reduce this risk Annual kidney health checks are recommended Kidney disease Kidney disease occurs when the nephrons inside your kidneys, which act as blood filters, are damaged. This leads to the build up of waste and fluids inside the body. If kidney disease is not diagnosed, it can lead to serious complications including kidney failure, which requires dialysis or a kidney transplant to keep you alive. Kidney disease and diabetes Each kidney contains up to one million nephrons, the filtering units of the kidneys. Inside a nephron is a tiny set of looping blood vessels called the glomerulus. Diabetes can damage the kidney filters, leading to diabetic kidney disease, or diabetic nephropathy. If kidney disease is found early, medication, dietary and lifestyle changes can increase the life of your kidneys and keep you feeling your best for as long as possible. Symptoms In some cases diabetic kidney disease causes the kidney filters to become blocked and stop working, which results in kidney failure. Symptoms of kidney failure may be general and can include: Changes in the amount and number of times urine is passed Blood in the urine Tiredness Loss of appetite Difficulty sleeping Headaches Lack of concentration Shortness of breath Nausea and vomiting Managing blood sugar levels can slow down the development of diabetic kidney disease. Kidney health check It is very important that diabetic kidney disease is detected early as treatment can help to increase the life of the kidneys. Your health care team can give you practical advice about the best way to keep your kidneys healthy. If you have diabetes your doctor should undertake a yearly kidney health check, which includes: Urine test to detect albuminuria A blood test to estimate the GFR (eGFR) Blood pressure test What is albuminuria? Albumin is a type of protein. The urine test is assessing the rate at which the kidneys are leaking a albumin into the urine. Albuminuria can lead to problems with the body’s fluid balance and result in swelling (oedema), often in the legs, feet, face and hands. The urine is tested with a special test strip in the laboratory. See your doctor immediately if you have any of the above signs of bladder or kidney infection. Any treatment that lowers levels of protein in the urine can help to reduce the rate of progression to kidney failure. ACE inhibitors or ARBs may be used to treat albuminuria. These drugs should be used even if blood pressure is in the desired range. Being a non-smoker It is well known that smoking harms the body. Smoking causes a narrowing of the arteries, including the small vessels in the kidney filters. This reduces the kidneys’ ability to work properly. If you have diabetes and smoke, the risk of developing albuminuria is much higher. Smoking also increased blood pressure. For reasons that are not well understood, smoking also appears to speed up the progression of diabetic kidney disease to kidney failure. High blood pressure Decreasing kidney function is usually linked with a rise in blood pressure. This rise is small at first and may only be detected by taking blood pressure over 24-hours. Even small rises in blood pressure need to be treated, as unmanaged high blood pressure increases the risk of kidney damage. If kidney damage is detected, high blood pressure medications called ACE inhibitors (medicines to treat high blood pressure and heart disease) help protect the kidneys from further kidney damage. Bladder and kidney infection Bladder and kidney infections are more common in women because of the short length of the urethra, which is the tube taking urine from the bladder to the outside of the body. The urine and vaginal secretions often contain increased amounts of glucose, particularly if the level of the glucose in the blood has been high. This provides an environment which germs (bacteria and fungi) can grow. It is possible for germs to be forced backwards up this tube during sexual intercourse, so to help prevent infection empty the bladder after sexual intercourse. If the nerves to the bladder have been damaged by diabetes, the bladder may not empty completely leaving germs that may multiply. Symptoms and treatment Prompt treatment of bladder and kidney infections is important. If left untreated may result in chronic kidney damage. In most cases antibiotics taken by mouth effectively treat infections. If you notice any of the following symptoms of a bladder or kidney infection contact your doctor immediately: Passing of small amounts of urine at more frequent intervals, day and night A burning discomfort or pain when passing urine Backache This is not an exhaustive list of symptoms and sometimes you may not even have any symptoms at all. If you notice that something isn’t right, always check with your doctor. For more information: contact Kidney Health Australia. Diabetes and incontinence type 2 diabetes If you live with type 2 diabetes, there is potential for your condition to exacerbate any bladder and bowel control problems you may be having. Being overweight is a condition that puts people at higher risk of both type 2 diabetes and incontinence. Overweight and obesity are major contributors to bladder and bowel control, because the excess strain placed on the pelvic floor muscles weakens them and compromises their ability to support the bladder and bowel, and to shut off the urinary and anal passages. Fluctuating blood glucose levels or long-term type 2 diabetes can cause damage to nerves, which can lead to problems with bladder and bowel control. This may manifest as a loss in sensation and having little warning about needing to go to the toilet or that your bladder is filling. There may be reduced sensation about whether or not the bladder or bowel is empty, increasing the risk of urinary tract infections (UTIs), kidney damage or constipation. Diabetes also interferes with the immune system which increases the risk of infection. This combination of immune system decline and poor bladder emptying due to nerve damage, puts people with diabetes at greater risk of UTIs. These can be treated with antibiotics and by practicing good personal hygiene; for example wiping from front to back to avoid contaminating the vagina with bowel bacteria. Content sourced from the Continence Foundation of Australia If you’re affected by incontinence, or want to avoid it, visit the Continence Foundation of Australia website for information on medications and healthy habits. If you are noticing any bladder or bowel control problems worsening, phone the National Continence Helpline on 1800 33 00 66.