Diabetes is a lifestyle disease that has drastically increased in India across all age groups. India is now referred to as the 'Diabetes Capital of the World', accounting for 17% of diabetes patients worldwide. The recently published Indian Chronic Kidney Disease (ICKD) study showed that the most common cause of CKD was Diabetic kidney disease (24.9%). Dr Vijay Varma Penmetsa, Consultant Nephrologist, Yashoda Hospitals, Hyderabad, says that typically patients with diabetic kidney disease (Diabetic nephropathy) leak protein in the urine and lose their kidney function.
Most often, in the early stages of diabetic nephropathy, they do not notice any signs or symptoms. Signs and symptoms that appear later on include:
Damage to blood vessels of other organs like the heart, brain, eye and legs can result in heart attack, brain stroke, decreased vision and foot ulcers, respectively.
Increased bone weakness, thereby causing an increased risk of fractures
Prevention
Early detection and proper treatment of diabetes can prevent diabetic kidney disease. Three simple tests can detect whether somebody has a kidney problem or not - which include:
A blood test called serum creatinine / estimated glomerular filtration rate (eGFR),
Ultrasound imaging of the kidneys to look at the kidney sizes and other parameters.
Those at risk of developing diabetic kidney disease should get their sugar and kidney function tests done more frequently (once quarterly or half yearly). Non-diabetics should get their annual health check-up done to detect any early abnormalities.
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Reduce salt intake: World Health Organisation recommends less than 5g daily. However, in an average household, Indian diets have been found to have around 10-12gsalt /day. This further increases if we take pickles, biryanis, street food and frozen foods. Reducing salt intake helps to prevent fluid retention in diabetic kidney disease, keeps the blood pressure under better control and also prevents the progression of the disease.
Keep your blood pressure under control: It is a good practice for all adults to check blood pressure once every month to pick up hypertension early. Those already hypertensive should be on regular follow-up and get it treated appropriately. Avoid using painkillers and other over-the-counter pills without clearance from your kidney doctor (nephrologist) or physician.
Prevent stone formation and urinary tract infection: Diabetics are at increased risk of uric acid stone formation and are also prone to develop urinary tract infections which can be additional insults to the kidneys.
Maintain a healthy weight and avoid smoking: It can harm your kidneys and exacerbate any damage.
Treatment
Diabetic kidney disease is a progressive disease. Treatments can only slow down the disease progression, which includes:
Reasonable control of sugars,
Treatment with drugs such as Angiotensin receptor blockers (ARBs) and ACE inhibitors reduce protein loss and keep blood pressure under control.
Newer diabetic drugs called SGLT2 inhibitors have been found to reduce protein loss.
Finerenone, a new drug released recently, has also been shown to reduce protein loss.
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