Diabetes is a multi-factorial, chronic, lifestyle disorder due to inadequate insulin production or secretion leading to high blood sugar levels. It can cause severe complications involving eyes, kidneys, blood vessels , heart and nerves.
Kidneys are vital organs of the body that help in removing waste products, balancing body fluids, maintaining blood pressure, producing red blood cells and strengthening the bones.
Diabetes and high blood pressure are responsible for 80 percent of cases of kidney failure.
Diabetes kidney disease (DKD) or Diabetic Nephropathy is the most common cause of chronic kidney disease (CKD), leading to end stage kidney disease or kidney failure.
The kidneys have glomeruli which filter the blood and remove the waste products and excess fluids by forming urine.
In diabetics, there are many mechanisms that contribute to damage of kidneys:
Increased sugar levels block the glomeruli and they are narrowed.
The blood flow thus is decreased and the kidneys are slowly damaged.
The blood vessels become leaky and there is loss of proteins in the urine.
Diabetes damages the nerves that innervate the bladder. The person cannot feel the sense of fullness of the bladder, thus leading to retention of urine and increased back pressure on the kidneys. This also increases the risk of urinary infections.
The high sugar levels in the urine also allow bacteria to grow rapidly, causing recurrent urinary tract infections (UTI).
All these factors slowly and steadily damage the kidneys.
Tests for kidneys
In the early stages of diabetic kidney disease, a person may not have visible symptoms. So, it is important to get the kidneys tested every year to detect any problem at an early stage.
A simple urine test called the Urine- Albumin Creatinine ratio (U-ACR) can detect the presence of protein (Albumin) in urine. Microalbuminuria (Alubumin in urine) is one of the first signs that can be picked up easily and treated.
The glomerular filtration rate (eGFR) test determines the ability of kidneys to filter out the waste products.
In the later stages, the person may experience swelling of ankles, feet and hands, frothy urine (due to the presence of albumin), blood in the urine (rare), shortness of breath, nausea, persistent fatigue.
Diabetic kidney disease develops over years. Therefore, the management is to slow the rate of the disease progression and to maintain and protecting the residual function of the kidneys.
Here are some tips to help keep your kidneys healthy:
Keeping the blood sugar levels in a normal range can help in protecting the kidneys from further damage.
Checking the blood sugar levels regularly.
Use a blood glucometer or check Fasting and Post Prandial blood sugars in the laboratory.
HbA1c gives an average level of blood sugar over the past 3 months.
Healthy eating habits should be inculcated. Include vegetables, lean protein and reduce carbohydrates and fats in the diet.
Reduce the consumption of sugary, oily foods and highly refined foods such as cookies, chips, chocolates and sodas.
Diabetics must consume small, frequent meals.
Consume less salt and processed foods as the high sodium content causes fluid retention.
Quit smoking or chewing tobacco as they can worsen the kidney damage.
Reduce the consumption of alcohol significantly to avoid any damage to the kidneys.
Regular exercise is vital. Being active helps the body to utilise insulin and glucose better and improves blood sugar control. Moderate-intensity exercises for at least 20 minutes every day for at least 5 days a week is recommended.
Control blood pressure and decrease the risk of kidney disease. Take Anti-hypertensive medications regularly.
Reduce cholesterol levels. High cholesterol levels increase their risk of kidney disease, heart disease and stroke. Avoid fatty foods and eat healthy.
Avoid drugs like NSAIDS, pain medicines and alternative medicines that are harmful to the kidneys.
Special renal vitamins are usually prescribed to kidney patients. Renal vitamins contain vitamins B1, B2, B6, B12, folic acid, niacin, pantothenic acid, biotin and a small dose of vitamin C.
Regular testing is the key to good treatment and control.
Type 2 Diabetics should get tested for kidney disease at diagnosis and yearly thereafter.
Type 1 Diabetics should get tested for kidney disease if they are diabetic for more than 5 years.
For any queries related to diabetes, speak to an endocrinologist or a diabetologist. And for any queries related to the kidney, consult a nephrologist.