Protect your kidneys
Kidneys are vital organs which clear wastes, make urine, control blood pressure and produce some essential hormones. Like many other organs, kidneys are also affected in people with uncontrolled diabetes. About 1 in 4 adults with diabetes have diabetic kidney disease (also known as diabetic nephropathy).
Diabetes not only affects kidney function directly but it also increases your risk of having various urological problems such as urinary tract infection and bladder dysfunction.
How does diabetes affect your kidneys?
Chronic hyperglycaemia (high blood sugar) damages the small blood vessels in the kidney. Due to this damage, the kidneys are unable to excrete waste and excess water properly. This leads to water retention (evident by weight gain and ankle swelling) and accumulation of toxic wastes in the body. Over time, if there is serious accumulation of toxins in the blood, (also known as uremia), it can lead to coma.
Most people with diabetes also have high blood pressure which hastens the process of kidney damage.
How do your kidneys work?
Kidneys have around a million filtering units called the nephrons. Each
nephron has two constituent parts - the glomerulus (a tuft of tiny blood
vessels) and the renal tubule. The glomerular blood vessels have a thin
semipermeable wall which allows small molecules such as water and
waste to pass through it and enter the renal tubule. Bigger molecules
such as proteins and blood cells stay in the blood.
The renal tubule keeps in the filtered waste (from the glomerulus), and
returns back necessary nutrients (minerals, vitamins) and water required
by the body, to a set of tiny blood vessels. The wastes, acids and excess
water together form the urine.
In conditions such as diabetes, the glomerular blood vessels become
leaky and allow passage of bigger molecules like proteins in the urine.
Risk factors and signs of kidney disease
Am I at risk?
If your blood sugar levels have been high for some years, there are high chances that you have diabetic kidney disease. If you have other complications such as diabetic retinopathy and neuropathy, you may be having nephropathy as well. Plus, the kidney disease risk increases if you have high blood pressure too.
Smoking
Obesity
Unhealthy food habits
High salt diet
Family history of heart disease
Sedentary lifestyle
Any signs that I should look for?
Most people develop symptoms of kidney disease only after 75 % of their kidneys get affected. This means that by the time you develop symptoms, it may be quite late. So, if you are a diabetic, it is always better to get your kidney function checked regularly.
The following are some of the symptoms of diabetic kidney disease:
- Difficulty in sleeping
- Poor appetite
- Itching and dry skin
- Swelling of the extremities
- Morning sickness and nausea
- Weakness and paleness
Early detection of kidney disease
Most people develop symptoms of kidney disease only after 75 % of their kidneys get affected. This means that by the time you develop symptoms, it may be quite late. So, if you are a diabetic, it is always better to get your kidney function checked regularly.
How frequently should I get my kidneys tested?
- Type 1 diabetic patients should go for urine and blood tests once every five years after their diagnosis.
- Type 2 diabetic people require more frequent testing. Talk to your doctor about when you should get tested.
1. Urine albumin to creatinine ratio: This test helps to detect even small amounts of albumin in the urine sample. Presence of albumin in urine is a sign of kidney disease.
Albumin and kidney disease:
Albumin is a protein that plays an important role in tissue repair, muscle building, and fighting infections. The job of your kidneys is to remove toxic wastes from the blood and retain important nutrients that your body needs- like albumin. When the kidney filters are damaged, albumin leaks out of the micro-blood vessels into the urine. Therefore, albumin is detected in the urine.
2. Estimated glomerular filtration rate (e-GFR): Glomerular filtration rate (GFR) is the amount of blood that is filtered by the kidney in one minute. As kidney function deteriorates, the GFR also decreases which leads to gradual accumulation of toxins in the blood.
The following are e-GFR levels and their associated conditions:
- ≥ 90 mL/min/ 1.73m² – Normal kidney function
- < 60 mL/min/ 1.73m² - Kidney dysfunction
- < 60 mL/min/ 1.73m² - (for consecutive three months) - Chronic kidney disease
3. Blood urea nitrogen: Urea is one of the important waste products that are removed by the kidneys. If your kidney function declines, urea levels increase in the blood.
4. Imaging tests: Imaging tests such as X-ray, ultrasound, CT and MRI are useful to find out any structural changes or obstruction in the kidneys.
Contrast dyes and kidneys:
Contrast dyes are an essential component of imaging studies such as CT and MRI. They help to pinpoint where exactly is the problem inside your body. On one hand, these dyes play an important role in diagnosing your condition, on the other, they also cause kidney dysfunction. Contrast induced nephropathy (CIN) is a condition in which there is serious decline in one’s kidney function within 24-48 hours of administration of the contrast dye. The risk of having CIN is more if you already have kidney disease or diabetes. To be on the safer side, discuss your health condition with the doctor before getting an imaging test. Also, find out if there are any options for getting the tests done without the use of the dye.
Prevention of kidney disease
High blood sugar levels for a prolonged period is the most important risk factor for diabetic kidney disease. So, take measures to keep your blood sugar levels in check.
Keep blood sugar levels in check
The HbA1c levels determine your average blood sugar levels in the past 3 months. Check your HbA1c periodically (ideally once every 3 months). Talk to your doctor to know your target HbA1c levels.
Don’t ignore your blood pressure (BP)
The risk of diabetic kidney disease increases if you have high blood pressure. High blood pressure should get treated right away. Blood pressure of 140/80 mmHg or less is considered as the target BP for most patients with high BP. Therefore, take your blood pressure medications regularly.
Take your meds as prescribed
Medications play a very important role in keeping your blood sugar levels within target range. Every diabetic has a different treatment plan. Your doctor would be the best person to tell you about the medicine, its time, dose, frequency, etc. Also, do not take any over-the-counter medications such as NSAIDs (commonly taken for pain and fever) without asking your doctor, as they can also cause kidney damage.
- Consult with your nutritionist to plan the most appropriate diet for you.
- Limit salt intake.
- Quit smoking.
- Exercise regularly.
- Achieve and maintain a healthy weight.
- Decrease stress and sleep well.
Lifestyle changes
Changes in lifestyle helps a great deal to attain control over blood pressure and blood glucose levels. Adopt the following changes to prevent kidney problems
Treatment of kidney disease
Diabetic nephropathy can be managed by treating diabetes and high blood pressure. The main aim of treating diabetic kidney disease is to get your blood sugar levels and blood pressure levels within the target range.
Medications: In the early stages of the condition, the following medications may be included in your treatment plan:
- Medicines to control high blood pressure
- Medicines to manage high blood sugar
- Medicines to lower high cholesterol
- Medicines to control protein leakage in urine and improve kidney function
If diabetic kidney disease is not detected and treated early, it may lead to end-stage kidney disease. This means only 10-15 % of the kidney is functioning. In this stage, you may have to opt for dialysis or transplantation.
