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About 1 out of 4 diabetic adults worldwide suffers from some kind of a kidney disease, says study published in the Journal of the American Medical Association. Diabetes mellitus is known to be the most common culprit behind kidney failure. In diabetic patients (especially those with type 1 diabetes), uncontrolled blood sugar levels rob the kidneys off their ability to filter out waste products and extra fluid from your body, which may finally lead to kidney failure. this condition is known as diabetic nephropathy.
During this life-long condition, your blood sugar goes up and high levels of circulating glucose damage your kidney nephrons (structural and functional units of the kidney), glomeruli (capillaries located within the kidney) and efferent arteriole (blood vessels in the urinary tract). These damages make your kidney unable to clean your blood properly leading to increased water and salt retention along with decreased glomerular filtration rate (amount of blood passing through glomeruli each minute). Also, increased sugar level can cause damage to your nerves further causing difficulty in urination. This can put extreme pressure on your bladder and kidneys eventually resulting in kidney failure , explains Dr. Sanjeev Gulati, Director, Nephrology and Kidney Transplant, Fortis Group of Hospitals.
The condition comes with symptoms like weight loss, dry and itchy skin, tiredness, poor appetite, swollen ankles, puffiness around the eyes, muscle cramps, and concentration problem. These symptoms are late, non-specific, and almost similar to signs of other common diseases. And, that s why most of the people do not even know about their condition until they have reached the last stage. This makes diabetic nephropathy a silent killer, says Dr. Gulati
There are 5 stages of diabetic nephropathy
Stage 1: During this stage, your kidneys start functioning faster and abnormally. This leads to increased urinary albumin (a protein made by liver) excretion especially during excessive physical exercise. At this phase, changes in the kidney function can be reversed back to normal.
Stage 2: A person reaches this stage after many years of origination of the condition. It is characterised by decreased glomerular filtration rate (approximately 89 to 60). As your kidney function gets worse, the GFR number goes down. Also, albumin excretion is even more at this stage, if blood sugar is not controlled.
Stage 3: During this phase, your kidneys go through mild to moderate loss of function with GFR number hovering between 59 to 30.
Stage 4: Greater than normal amount of protein is found in the urine at this stage with the GFR count around 29 to 15.
Stage 5: This is the last stage of diabetic nephropathy that is characterized by symptoms of kidney failure like excessive fluid retention causing swelling in ankles and legs and decreased urine output. In this phase, your GFR count comes down to less than 15.
POSSIBLE RISK FACTORS
A diabetic with high blood pressure is more at risk of diabetic nephropathy. Hypertension potentially stops nephrons present in your kidneys to receive the oxygen and nutrients required to perform their functions well. This damages the nephrons and hinders their function of filtering waste materials out of blood. Other possible risk factors include smoking, obesity, age, sex, and race.
DIAGNOSIS
Diabetic nephropathy is diagnosed through blood and urine tests. During blood test, doctors check the estimated glomerular filtration rate. However, urine test is done to detect the amount of albumin(a protein) and creatinine (waste product) present in urine.
LINE OF TREATMENT
In case of mild kidney damage, doctors try to control the symptoms with medicines. However, in a severe condition (kidney failure), you are left with only two treatment options, namely kidney transplant and regular dialysis.
Kidney transplant includes replacement of your kidneys with a healthy donor kidney through surgery. Dialysis involves cleansing of your blood at least every 3 days a week. It is of two types namely hemodialysis and peritoneal dialysis. During hemodialysis, a dialysis machine is connected to your body through a needle in the vein of your arms. This allows your blood to come out of your body, enter the machine to be clean and then return to the body. This whole process requires at least three hours. Now, in case of peritoneal dialysis, a cleaning solution called dialysate is put inside your abdomen, which absorbs fluid and waste material from your blood using your peritoneum (lining of abdomen) as a filter.
DOCTOR-BACKED PREVENTION TIPS
In order to prevent the occurrence of this severe condition, follow these golden rules approved by Dr. Gulati.
Control your blood sugar level: Increased blood sugar levels potentially damage millions of tiny filtering units in your kidneys. This allows the waste products and fluids to deposit in your blood leading to kidney failure.
Exercise on a regular basis: Daily workout is advised to every diabetic patient as it increases their oxygen intake and keeps their organs in good condition. Also, if you are obese, fat deposition in your body will increase your chances of getting diabetes or high blood pressure, the high risk factors for diabetic nephropathy. Therefore, exercise every day. Religiously!
Control your blood pressure: Due to increased blood pressure, your blood vessels get stretched. This weakens their ability to perform required functions properly.
Eat healthy: People with diabetic nephropathy are advised to limit their consumption of sodium, potassium, and phosphorous. Damaged kidneys become unable to filter out excess sodium and phosphorous causing increased levels of these nutrients in the blood. Though potassium plays an important role in various physiological functions, too much of it can dangerously increase your blood pressure levels. Avoid salt, banana, raisins, oranges, and dates as these are rich in these three nutrients. You can opt for foods like blueberries, red grapes, egg whites, garlic, olive oil, cabbage, and pineapples for help your kidneys.
Keep your kidneys hydrated: Good amount of fluid in your body will help your kidneys excrete out urea, sodium, and toxins from the body effectively. Everyone should drink at least 3 litres of water every day.
Quit smoking: Smoking can potentially slow down your blood flow to the kidneys. This will interfere with your kidney s ability to function properly. Also, if you have high blood pressure and you are taking medicines for it, smoking can affect their function as well. According to a study published in the Clinical Journal of American Society of Nephrology, smoking is a risk factor for progression of chronic kidney disease.
Avoid over-the-counter NSAIDs: A research published in the journal Pharmaceuticals has revealed that excess intake of non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen is a potential risk factor for end stage renal disease. If your doctor recommends NSAIDs for the treatment of arthritis and back pain and you are also suffering from diabetes and hypertension, tell him about your condition so that he changes the medication accordingly.
Get your kidney checked asap if you fall in high-risk group: Diabetes, hypertension, obesity or a family history of kidney disease are considered to be some of the major risk factors behind diabetic nephropathy. If any of these factors matches your condition, immediately visit a doctor and get your kidney function checked.
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