The kidneys play an important role in the body: they filter the blood, removing waste products and excess salt and water. If the kidneys become diseased, the body is unable to get rid of the metabolic waste products leading to their accumulation in blood. Having diabetes puts a person at risk of other health problems, including heart attacks, strokes, vision loss, nerve damage, and kidney disease. People who develop diabetic kidney disease usually have no symptoms early on, until at least 80 per cent of their kidneys' function is lost, although the condition puts them at risk of developing more serious kidney disease. It is important to take steps to protect the kidneys before the problem advances.
How Do You Know If Diabetes Is Affecting Your Kidneys?
Dr. Alka Bhasin, who is the Senior Director – Nephrology, at Max Smart Super Speciality Hospital, Saket said, "Healthcare professionals use blood and urine tests to check for diabetic kidney disease. These include serum creatinine measurement and urine for protein/creatinine ratio as well as the simple urine routine test."
She added that kidney damage is more likely if you:
- Have uncontrolled blood sugar (glucose)
- Are obese
- Have high blood pressure
- Have type 1 diabetes that began before you were 20 years old
- Have family members who also have diabetes and kidney problems
- Smoke
- Have coexisting diabetic retinopathy and neuropathy
Risk Factors For Diabetic Kidney Disease:
Dr Sonali Kagne, who is a Deputy Consultant, Department of Endocrinology, at Sir HN Reliance Foundation Hospital, Mumbai listed down the risk factors for diabetic kidney disease:
- Having a family history of kidney disease or belonging to certain ethnic groups (e.g., African American, Mexican, Pima Indian) can increase the risk of diabetic kidney disease.
- Although one cannot do anything to change their family history, there are several factors that increase your risk of developing diabetic kidney disease that can be changed and controlled. These include:
- Smoking
- Being overweight or obese
- Having chronically elevated blood sugar levels
- Having high blood pressure
- Having high cholesterol
- Having a diabetes-related vision problem (diabetic retinopathy) or nerve damage (diabetic neuropathy)
Diagnosis Of Diabetic Kidney Disease:
Finding out that you have early diabetic kidney disease can alert you that your kidneys are in danger. To detect diabetic kidney disease, healthcare providers rely on tests that measure protein (albumin) levels in the urine and blood tests to evaluate the level of kidney function.
Dr Sonali said, "When the kidneys are working normally, they prevent albumin from leaking into the urine, so finding albumin in the urine is a sign that the kidneys are in trouble. If there is a very large amount of albumin in the urine of a person with diabetes, it means they have diabetic kidney disease."
"Often people who have diabetic kidney disease also have high blood pressure. Urine tests are recommended once per year in people with type 1 diabetes, beginning about five years after diagnosis, and in people with type 2 diabetes, starting at the time of diagnosis," she added.
Complication Of Diabetic Kidney Disease:
A key complication of diabetic kidney disease, as mentioned by Dr Sonali, is more advanced kidney disease, called chronic kidney disease. In some cases, diabetic kidney disease can eventually cause the kidneys to stop working altogether. If that happens, the person may need to have a kidney transplant or dialysis, a procedure that filters the blood artificially several times a week. Also, if a person’s kidneys are diseased, their risk of heart attacks and heart failure could be higher.
Treatment Of Diabetic Kidney Disease:
Dr. Sonali suggested the most important things you can do to stall kidney disease and protect against other diabetes complications:
- Make healthy lifestyle choices
- Keep your blood sugar as close to normal as possible
- Keep your blood pressure below 130/80, if possible
"Most people with type 2 diabetes and kidney disease should be treated with a sodiumglucose co-transporter 2 (SGLT2) inhibitor. Changing your lifestyle can have a big impact on the health of your kidneys," she added.
The following measures are recommended by Dr. sonali for everyone, but are especially important if a person has diabetic kidney disease:
Limit the amount of sodium (salt) you eat to less than 2 grams per day
If you smoke, quit smoking
Lose weight if you are overweight
Blood sugar control — Keeping blood sugars close to normal can help prevent the longterm complications of diabetes mellitus. For most people, a target for fasting blood glucose and for blood glucose levels before each meal is 80 to 120 mg/dL (4.4 to 6.6 mmol/L); however, these targets may need to be individualized. A blood test called A1C is also used to monitor blood sugar levels; the result provides an average of blood sugar levels over the last one to three months. An A1C of 7 per cent or less is usually recommended; this corresponds to an average blood glucose of 150 mg/dL.
Managing high blood pressure — Many people with diabetes have hypertension (high blood pressure). Although high blood pressure causes few symptoms, it has two negative effects: it stresses the cardiovascular system and speeds the development of diabetic complications of the kidney and eye. Measures such as weight loss, exercise, decreasing the amount of salt in the diet, quitting smoking, and decreasing alcohol intake can sometimes reduce mild blood pressure to normal. Others may have to be on blood pressure-lowering medications to achieve normal BP levels. A blood pressure reading below 130/80 is the recommended goal for most people with diabetic kidney disease, especially if you have more than 300 mg of albumin in your urine per day.
Blood pressure medications — Several medications can be used for this purpose, but a medication known as an angiotensin-converting enzyme inhibitor (abbreviated ACE inhibitor) or a related drug known as an angiotensin receptor blocker (ARB) should be used because they decrease the amount of albumin in the urine and can prevent or slow the progression of diabetes-related kidney disease.
Ongoing monitoring — After beginning treatment and lifestyle changes to prevent kidney disease, a person with diabetes will need to repeat the same urine and blood tests to determine if urine albumin levels have improved. They may need necessary changes in their medications as per the results of the current reports.
Prevention For Diabetic Kidney Disease:
Dr. Alka Bhasin listed out the tips for prevention of diabetic kidney disease:
- Tight control of sugars
- Tight control of blood pressure
- Low salt, diabetic healthy diet
- Regular exercise 30-45 min/day
- Avoidance of urine infections
- Avoidance of pain killers such as brufen, diclofenac variety
- Avoidance of ayurveda / unani / herbal / homeopathy drugs
- Avoidance of intravenous ” dye “ used for CT scan / PET CT scan / angiograms
Diabetics are more prone to urinary tract infections, prostatic infections, diabetic bladder dysfunction, renal papillary necrosis.
"If detected with kidney disease, do not panic - meet a Nephrologist who will help stage the disease based on estimated GFR (glomerular filtration rate) – i.e. kidney filtering efficiency. Ultrasound to determine kidney size and architecture will also be done besides blood and urine investigations. Medications such as Angiotensin receptor blockers and SGLT2 inhibitors are helpful in decreasing protein leak via urine and slowing down the progression of diabetic kidney disease besides lifestyle modification," she added.
Lastly, Dr. Prakash Chandra Shetty, who is a Urologist, at Dr. LH Hiranandani Hospital, Powai, Mumba concluded, "It’s imperative to highlight that the relationship between diabetes and kidney health is not confined to diabetic nephropathy alone. Diabetes also is a significant risk factor for other kidney-related complications, including kidney stones, urinary tract infections, and heightened vulnerability to kidney infections. These additional barriers highlight the need for a more integrated approach to care for people with diabetes. A multimodal approach to diabetes care, including healthy lifestyle behaviors, medication adherence, and regular check-ups, can help preserve kidney health and prevent the devastating effects that diabetes can have on the kidneys."