Hypertension & Diabetes: The Road to Renal Failure

by Dr. Saurabh Pokhariyal

There are several conditions and diseases that can lead to chronic kidney disease (CKD). Hypertension (High blood pressure) and diabetes are just two of the most common causes. Blood pressure is determined by the force of blood being pumped from the heart, and force of blood against the walls of the arteries. When uncontrolled, blood pressure can be life threatening. Blood pressure that is high makes the heart work too hard, harden the walls of arteries, and can lead to a stroke or heart disease. It can also cause significant kidney damage.

A blood pressure reading of 140/90 mmHg or higher is considered high. Normal blood pressure is less than 120/80 mmHg. Over time, uncontrolled high blood pressure can damage the blood vessels and nephrons (functional units of the kidneys) in the kidneys. This causes the nephrons to stop doing their job of filtering out wastes, sodium and excess fluids from the blood thus putting extra pressure on the walls of the blood vessels, and raising the blood pressure even higher. This extra pressure damages the kidneys even further.

On Your Visit to the Doctor…Remember to Ask:
  • What is my blood pressure reading number? (a blood pressure reading of 140/90 mmHg or higher is considered high)

  • What should be my blood pressure goal?

  • What is a healthy weight for me? (obesity increases Blood pressure )

  • Is it safe for me to start doing regular physical activity?

  • Would you recommend I start taking blood pressure medication and if so, what is the name of it?

  • Should I change my diet in any way?

Four ways to lower your blood pressure are:
  • losing weight,
  • eating less salt,
  • avoiding alcohol and tobacco,
  • and getting regular exercise.
  • Diabetes is another condition that can lead to CKD. Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. Diabetes often goes undiagnosed because many of its symptoms seem harmless.
    • Frequent urination
    • Excessive thirst
    • Extreme hunger
    • Unusual weight loss
    • Increased fatigue
    • Irritability
    • Blurry vision
  • If detected early, treatment can decrease the chance of developing the many complications of diabetes. Not everyone with diabetes develops kidney disease. Factors that can influence kidney disease development include genetics, blood glucose (also called blood sugar) control and blood pressure. It’s important to control your blood glucose. Keeping your glucose level close to normal helps prevent or delay some diabetes problems, such as eye disease, kidney disease and nerve damage.
You can do this by:
  • Testing your own glucose a number of times each day (self-monitoring blood glucose).
  • Getting an A1C test about every 3 months if you take insulin and at least every 6 months if you don’t take insulin.
  • It is very important that diabetic patients also keep tight control of their blood pressure. The target blood pressure is 130/80 or less and if a patient has significant protein in the urine then 125/75 or lower. Blood pressure has a dramatic effect on the rate at which kidney disease progresses. Even a mild rise in blood pressure can quickly worsen kidney disease.
  • One of the first signs of renal failure is when your kidneys leak small amounts of protein called albumin into the urine. This is called microalbuminuria. If the condition worsens, overt proteinuria can develop. It is vital to see a doctor regularly. The doctor can check blood pressure, urine (for protein), blood (for waste products), and organs for other complications of diabetes.
Again, diabetes and hypertension are just two conditions that can lead to CKD but they are the most important reasons for CKD and patients with these conditions should be regularly assessed for kidney disease.