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Diabetes is the leading cause of impaired kidney function. Today, as we observe World Kidney Day, doctors urge people to be aware of the warning signs
If you’re living with diabetes, there’s a chance your kidneys could face a condition called diabetic kidney disease. Doctors refer to the condition as diabetic nephropathy, which occurs when high blood pressure or high blood sugar from diabetes hurts the kidneys.
Diabetes mellitus is the leading cause of kidney disease worldwide. The harsh reality is that at the time when Type 2 diabetes is diagnosed, approximately 7.5 per cent of patients already have early diabetes-related kidney disease. In the UAE, as in most parts of the world, diabetes and hypertension are the biggest risk factors for kidney disease. Nearly 80 per cent of kidney damage can be attributed to these two conditions.
If a diabetic patient has abnormal kidney function manifested by increased albumin (protein) excretion in urine and reduced filtration function (glomerular filtration rate) of the kidney, he/she is said to have diabetic kidney disease.
What is diabetic nephropathy?
If a diabetic patient has abnormal kidney function manifested by increased albumin (protein) excretion in urine and reduced filtration function (glomerular filtration rate) of the kidney, he/she is said to have diabetic kidney disease,” explains Dr Abeesh Padmanabha Pillai, Specialist Nephrologist – Lifecare Hospital, Musaffah. “This kidney disease is diagnosed by measuring the albumin level in urine, commonly known as microalbuminuria and blood test to assess the level of kidney function. These tests help not only in diagnosing kidney disease but also to monitor the kidney status over a time period.”
About 30 per cent of patients with Type 1 (juvenile onset) diabetes and 10 to 40 per cent of those with Type 2 (adult onset) diabetes will eventually suffer from kidney failure. Injury to blood vessels in the kidneys leads to protein leak in the urine. The result is weight gain and ankle swelling due to retention of water, salt and amines.
Diabetes also may affect bladder emptying due to damage of the nerves. This can precipitate a rapid growth of bacteria in urine that has a high sugar levels, leading to urine infection.
“Diabetes also may affect bladder emptying due to damage of the nerves,” says Dr John Cherian Varghese, Specialist Nephrologist, Aster Hospital and Aster Jubilee Medical Complex. “This can precipitate a rapid growth of bacteria in urine that has a high sugar levels, leading to urine infection.”
Long standing diabetes, especially uncontrolled, damages small blood vessels in the kidneys (which are the basic functional sub-unit of the kidneys), thus creating a microvascular complication of diabetes. “It is usually associated with other microvascular complications like diabetic retinopathy/neuropathy and is often accompanied with hypertension,” says Dr Sandeep Varma, Specialist Nephrologist, Prime Hospital. “Apart from classical diabetic nephropathy, diabetic people commonly have infection with secondary renal dysfunction, diabetic bladder with resultant kidney involvement secondary to urinary obstruction and kidney disease secondary to hypertension, which commonly coexist with diabetes.”
Apart from classical diabetic nephropathy, diabetic people commonly have infection with secondary renal dysfunction, diabetic bladder with resultant kidney involvement secondary to urinary obstruction and kidney disease secondary to hypertension, which commonly coexist with diabetes.
The causes
After about 15 years of diabetes around 20 per cent to 30 per cent of the patients have microalbuminuria and about 50 per cent of these patients can develop severe kidney disease during the course.
“Older age, low socioeconomic status, obesity, smoking, poor glycaemic and blood pressure control and genetic factors are some of the risk factors for diabetes related kidney disease,” says Dr Pillai. “Persistent uncontrolled blood sugar results in formation of abnormal compound called advanced glycation end-products (AGE) in the blood. Along with this AGE, other factors like resistance to insulin action , increased insulin levels and altered glomerular hemodynamics damage the filtering membranes of kidney (glomerular basement membrane) making them more leaky, which is reflected in urine as microalbuminuria. In due course, the filtration function of kidney (glomerular filtration rate) is progressively reduced leading on to permanent kidney damage.”
Dr Sandeep Varma, Specialist Nephrologist, Prime Hospital, says about 25 per cent of all diabetics could develop diabetic kidney disease. “Uncontrolled blood sugars, uncontrolled hypertension, obesity, smoking, frequent use of analgesics and inappropriate use of other medicines all increase the risk and severity of kidney involvement with diabetes mellitus. Diabetics are more prone for infection and hence get infection associated renal dysfunction.”
If you are living with diabetes, visit your doctor yearly or as recommended by the treating physician, for tests that measure kidney function at regular intervals.
Symptoms
In the early stages of diabetic nephropathy, you would most likely not notice any signs or symptoms. In later stages, signs and symptoms may include worsening blood pressure control, protein in the urine, swelling of feet, ankles, hands, or eyes, increased need to urinate, reduced need for insulin or diabetes medicine, confusion or difficulty concentrating, shortness of breath, loss of appetite, nausea and vomiting, persistent itching, and fatigue.
“You need to visit your doctor if you have any signs or symptoms of kidney disease,” says Dr Prem Geovanni Johnson — Specialist Nephrology, Aster Hospital, Al Qusais. “If you are living with diabetes, visit your doctor yearly or as recommended by the treating physician, for tests that measure kidney function at regular intervals.”
Managing the condition
While it is not possible to reverse kidney damage resulting from diabetes, people can implement strategies to prevent or delay complications. Taking good care of your kidneys is extremely crucial, especially when an individual is diabetic. Damage can get worse over time, as more protein leaks into your urine. It can also lead to elevated blood pressure and waste materials building up in your blood.
High blood pressure can be a sign of kidney problems. Get it checked during every hospital visit as your doctor will tell you what levels are normal for you. Besides, blood tests and urine tests that gauge the levels of blood urea, protein and creatinine can tell the percentage levels of kidney function.
“High blood pressure can be a sign of kidney problems,” says Dr Rajaram Jagdale, Specialist Nephrologist, Thumbay University Hospital. “Get it checked during every hospital visit as your doctor will tell you what levels are normal for you. Besides, blood tests and urine tests that gauge the levels of blood urea, protein and creatinine can tell the percentage levels of kidney function.”
Eating healthier and ensuring regular exercise can improve your overall blood glucose, blood pressure, and cholesterol levels. Also, these factors affect how hard your kidneys have to work. Your doctor may recommend to cut down on protein, salt, and fat in your diet. It’s also advisable to watch your alcohol intake, stop smoking and maintain good levels of water intake. “One should also avoid taking too many painkillers, or using nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen on a routine basis as these can lead to kidney damage,” says Dr Jagdale. “Lastly, monitoring your blood glucose regularly at home is important.”
Treatment options
The medications used for blood pressure called angiotensin converting enzyme (ACE) inhibitors and Angiotensin receptor blockers (ARB) have been proven to help slow the loss of kidney function. “Newer studies have emerged to show benefit of using an oral antidiabetic drug (SGLT2 inhibitors) to protect the kidney while controlling the sugars,” says Dr Varghese. “The control of diabetes and preventing kidney complications, will require a collective effort from the patient, his primary care physician, the nephrologist, a nutritionist and a physical trainer.”
When you have diabetes and kidney disease, stress can significantly affect your ability to control the disease. Although you can’t completely remove stress from your life, there are several ways you can reduce it. And by learning to better manage stress, you can help keep your disease under control.
The plan of management will differ according to the stage of diabetic kidney disease, as our target in the beginning is to stop the regression of renal functions and to avoid kidney damage. After stabilisation, our target will be to help the patient’s organs regain some of the lost functions. But we have to know that chronic kidney disease over months and years is usually irreversible. Acute cases occurring on top of chronic disease are correctable and reversible only if treated early and in the proper way.
As a first step in managing diabetes, patients have to accept that they will need to live and cope with it throughout their lives, explains Dr Moamen Amin Abdelrahim, Consultant Urologist, Medcare Hospital Sharjah. “When we deal with it in a good way, it will be controlled without much suffering. We may have seen examples among our families and friends, of how a normal life can be led if the condition is managed effectively.”
Diabetic kidney disease can get worse with time if we don’t care about our sugar levels, blood pressure, or cholesterol level. We also need to closely monitor our kidney functions, and follow the physician’s instructions regarding diet and lifestyle modifications.
“We are commonly discovering diabetic kidney disease accidentally on routine investigations for diabetes as the early stages are asymptomatic,” says Abdelrahim.
“The plan of management will differ according to the stage of diabetic kidney disease, as our target in the beginning is to stop the regression of renal functions and to avoid kidney damage. After stabilisation, our target will be to help the patient’s organs regain some of the lost functions. But we have to know that chronic kidney disease over months and years is usually irreversible. Acute cases occurring on top of chronic disease are correctable and reversible only if treated early and in the proper way.”
