Urinary Tract Infection

Many women with diabetes suffer especially frequently from urinary tract infections. These are 2–4 times more common than in women without diabetes. For men with diabetes there seems to be no such increased risk for this type of infection.

Some urinary tract infections are not noticeable; they are detected by the doctor during a routine check for bacteria in the urine. This form is known as ‘asymptomatic bacteriuria’. Frequently, however, the typical pains associated with such an infection are felt.

While it is not clear whether it is worth treating asymptomatic bacteriuria with antibiotics, as soon as symptoms are noticed – or if the infection reaches the kidneys – a course of antibiotics should be taken. This is particularly important when the kidney has already suffered some damage.

At the end of the treatment, the urine should be tested again, to be certain that the infection has been cleared successfully. If the infection continually reappears, at intervals of several weeks, the underlying cause should be sought: this might be bladder or kidney stones, an anatomical defect of the urinary tract or pockets in the bladder where urine might accumulate.

Diabetic neuropathy may also be a cause of frequent infections, if the damage means that the bladder is not emptied properly and residual urine is retained, which acts as a breeding ground for bacteria. The urine may even back up into the kidneys, adversely affecting their function.

Because the concurrent nerve damage leads to loss of sensation and therefore no feelings of pain, the patient may remain unaware of all this for some time. A urological examination should be undertaken to determine whether there is any obstruction of the urinary flow, such as an enlarged prostate or narrowing of the urethra.

If these are excluded, one can try to empty the bladder through regular urination ‘by the clock’, i.e. every 3–4 hours, and to train it to empty properly again through tightening of the abdominal muscles.

A class of drugs that acts on the autonomic nerves controlling the bladder, the parasympathetic mimetics, can help. If the bladder function cannot be fully restored by these methods, eventually a catheter must be inserted or the patient has to undergo an operation.

X-ray Examinations

Today, to make a given organ, such as the intestine or urinary tract, more clearly visible using X-rays, people are often given a contrast agent. But in people who already have kidney impairment, these diagnostic materials should be used only reluctantly because of the danger that the contrast agents will cause additional damage to the kidneys.

A worsening of kidney function after administration of such contrast agents can be detected by a rise in the amount of creatine and urea in the serum. This rise is usually transient and after a few days kidney activity has returned to its normal value. Sometimes, however, these blood parameters stay high, which indicates that more permanent damage has been done to the kidneys.

The first priority is to ask whether an examination using a contrast agent is absolutely necessary or whether another less stressful diagnostic method, such as ultrasound, could be used. If the use of a contrast agent cannot be avoided, care should be taken that the body is at no time dehydrated.

If insufficient fluid is available in the body, this will lead to concentration of the contrast agent in the kidneys, which increases the detrimental effect. You should therefore drink a lot before and after such an examination. The fluid reservoir of the body can be replaced via a saline infusion.

High blood sugar levels have a dehydrating effect on the body as it tries to remove the excess sugar by excretion through the kidneys. Before an examination using contrast agents, you should therefore pay extra attention to controlling your blood sugar.

It has also proved beneficial to stop taking ACE inhibitors and possibly other types of medication (such as antirheumatic drugs). These may be started again one or two days after the examination. Biguanides (metformin) should also be stopped two days before the examination.

This is a precaution, so that if the contrast agent does cause kidney damage, the concentration of the biguanide in the body does not increase, leading to a dangerous acidosis. If an X-ray examination with a contrast agent is necessary, even in the presence of marked kidney impairment, it is advisable to remove the contrast agent by dialysis as quickly as possible after the examination.

Dental Problems with Nephropathy

Inflammation of the gums (gingivitis) and surrounding areas (parodontitis) is widespread in the population. Young adults already have, on average, 17 teeth with decay and fillings; only half still possess all their teeth! The main causes are poor oral hygiene and bad tooth-brushing technique, through which the bases of the teeth are exposed.

This makes it easy for bacteria to attack the roots of the teeth. By middle age, 40–80% of people already have caries in the roots of their teeth! Statistically, people with diabetes do not do well in terms of dental health.

Problems with the teeth and gums are three times more frequent than in people of the same age with normal metabolism; decay appears earlier and is more pronounced. Harmful bacteria are often found in pockets in the gums, especially at times of poor metabolic control.

It has been known for a long time that pus in the roots of the teeth can be a forerunner of various illnesses or complaints: fever, pain in the joints, changes in the blood composition, and inflammation in other organs infected by the bacteria, including the kidneys.

Infection of the kidneys is indicated by the presence of red and white blood cells in the urine, as well as protein in the urine and other specialized changes. It is not known how often this occurs. When there is frequent oral infection, the risk to the kidneys is certainly considerable.

Particularly when the kidneys are already damaged and therefore more susceptible. Exposure to this additional risk is totally unnecessary, since it can easily be avoided by good mouth and dental care – something that is not difficult to achieve. Another point worth noting concerns fillings made from amalgam.

The pros and cons of materials containing mercury have been debated since these compounds were first used and do not need to be repeated here. If you have impaired kidney function and thus a reduced ability to remove toxins from your body, you should ask whether any amalgam fillings can be replaced with those made from other materials.