The number of people getting diagnosed with diabetes is increasing day by day, and with that a parallel rise in diabetes complications is seen. Fluctuating or poorly controlled blood sugar levels can affect every system of the body, including the renal system. A significant rise in the prevalence of chronic kidney disease (CKD) has been observed in elderly people suffering from diabetes. According to a hospital based study, about 46 % of diabetics are currently suffering from kidney disease.
Whether you have been recently diagnosed with diabetes or you’re living with the condition since a very long time, you should be aware about your chances of developing diabetic kidney disease, medically called diabetic nephropathy. Our expert Dr Avinash Ignatius, senior consultant nephrologist, gives a detailed account of the condition.
Each kidney has about 1 million filtering units called nephrons. Each nephron is about the thickness of a human hair. A tiny tuft of blood vessels (glomerulus) in each nephron filters waste from the blood under pressure. High blood sugar levels due to diabetes can damage these blood vessels, leading to leakage of protein and eventually kidney failure.
All diabetics are prone to kidney damage. However, the chances of developing diabetic nephropathy depends on a number of factors. Some diabetics may suffer from kidney damage right at the time of diagnosis of diabetes, while others may not develop it even after 20- 25 years.
The following factors are major risk factors for diabetic nephropathy:
- Family history
- Genetic predisposition
- Level of control of blood sugar levels
- Uncontrolled blood pressure.
The following symptoms may be seen in people suffering from severe or long-term kidney damage -
- Swelling in the legs due to fluid accumulation
- Sleep problems
- Loss of appetite
- Stomach upset
- Poor concentration
The symptoms of kidney damage are same for both type 1 and type 2 diabetics. But there is a difference in the onset of kidney damage in type 1 and type 2 diabetes. The onset of diabetic nephropathy in type 1 diabetes is much later, usually 5 -10 years after the diagnosis of diabetes. However, in type 2 diabetics (the more common type of diabetes), 20 -30% may have diabetic nephropathy at the time of diagnosis of diabetes itself. Read more about causes, symptoms, diagnosis and treatment of diabetes.
Dietary changes, self care and medication are the main options for treatment of diabetic nephropathy.
Dietary changes mainly involve eating a healthy, low protein diet. Self care includes controlling diabetes, managing blood pressure, following an active lifestyle, limiting alcohol intake and avoiding self medication.
ACE inhibitors and angiotensin receptor blockers are blood pressure lowering drugs that may be prescribed for slowing down the progression of kidney damage. They are not only effective for diabetics suffering from high BP but also in diabetics who don’t have hypertension.
When is a kidney transplant done?
Kidney failure may occur with progression of diabetic nephropathy. If the kidneys fail, either dialysis or kidney transplant is required.
‘Kidney transplant is required only when the kidneys have lost 85-90% of their function, till then it can be managed with medicines. Early stages of diabetic nephropathy – stage of microalbuminuria, the damage to the kidneys can even be reversed with proper treatment, and microalbuminuria may disappear,’ says Dr Avinash.
Here are some tips that can help you to prevent kidney damage if you’re a diabetic.
- Good sugar control with diet and lifestyle.
- Following medication including insulin (if needed) is the most important.
- Monitoring of HbA1c (glycosylated hemoglobin) should be done every 3 months to know your average sugar control.
- Monitor your blood pressure on a regular basis, and keep it under control.
- Monitor your cholesterol levels and keep under control.
- Avoid tobacco in any form (smoking, chewing, etc..).
- Keep your weight under check.
- Avoid self medication, especially painkillers.
- Get renal function tests done every year, especially urine for microalbumin and serum creatinine.
Read more about causes, symptoms, diagnosis and treatment of kidney disease.
The content has been verified by Dr Avinash Ignatius, senior consultant nephrologist.