What is the Effect of Diabetes on Kidney Health?
Diabetes is the leading cause of renal disease around the globe. Kidney damage occurs in about 30 percent of patients with Type 1 Diabetes and up to 10-40 percent of patients with Type 2 Diabetes.
As the prevalence of diabetes is rising in the world, so is kidney damage caused by it. Diabetes is also the leading cause of kidney failure requiring dialysis or transplant as replacement therapy.
What are the different symptoms of kidney disease in diabetics?
Kidney disease is a silent disease (asymptomatic), hence you do not manifest any symptoms of Diabetic kidney disease till the damage is significantly advanced and have lost the majority of your kidney function.
Following are a few symptoms that may present in these patients
- Worsening blood pressure control, patients may notice a loss of BP control on medications that they were taking previously
- Protein loss in Urine which may be revealed on testing or the patient may notice Frothing of urine.
- Swelling over feet marked by indentation of slippers, shoes, or socks on feet, swelling may also develop around face and eyes, and patients may also look bloated.
- Increased frequency of passing urine or waking up multiple times to relieve themselves at night
- Loss of appetite
- Tiredness
- Reduced need for insulin or anti-diabetic medications for sugar control, as kidney function worsens patients notice that their diabetes is easily controlled this could mislead the patients to believe that their diabetes is getting better but their kidneys are getting worse.
What are the risk factors for kidney disease in diabetics?
- Elevated blood sugar for a prolonged period
- Diabetes-related retinopathy
- Obesity
- Uncontrolled blood pressure may cause a rapid decline in kidney function
- Smoking not only causes worsening of Kidney function but substantially increases Cardiovascular risk above that caused by Diabetes alone.
- Family history of Kidney involvement due to Diabetes
How is a kidney disease in diabetics diagnosed?
- Albumin is a type of protein present in our body and is not normally present in urine. Diabetic patients develop a loss of albumin through their urine called albuminuria. Albuminuria is often the first sign of developing kidney disease in diabetics. It should be checked routinely at diagnosis of kidney disease. If albuminuria is present, it should be treated and monitored. If absent initially yearly screening should be done.
- Kidney function test to determine estimated glomerular filtration rate (eGFR) is done, diabetic patients usually have gradually declining eGFR over the years.
- Ophthalmological evaluation is done to see if changes of diabetes are present in one’s retina.
- Diabetic kidney disease is highly likely if the above features are present. Some patients who do not fit in these patients’ clinical scenarios may need a Kidney biopsy to make a diagnosis with certainty.
How can diabetic kidney disease be prevented and its progression slowed?
- Sugar and BP Control- Tight sugar control from the onset of diabetes significantly reduces the risk of developing diabetic kidney disease. Targeting Fasting blood sugar between 80-130 mg/dl and less than 180 mg/dl 2 hours after meals is considered good control. The target for A1C is less than 7 %.
- many new drugs are available and some are in the pipeline for diabetic kidney disease patients. Drugs like SGLT2 inhibitors are available in India and have been proven to be good in preserving kidney function in such patients.
- Other drugs Like MRA’s which will soon be available in India also is another class of medications that are kidney protective.
- Similarly, blood pressure is kept under control below 130/80 mmHg. Certain antihypertensive medications e.g ACEi/ARB have a significant role in not just blood pressure control but also provide kidney protection.
- Lifestyle modification- Losing excess weight and regular exercise will also improve and facilitate controlling blood sugar levels. Blood pressure also becomes easily managed and the pill burden on the patient could be reduced. These changes lead to better cardiovascular health as well.
- Losing as little as 5 percent of their body weight is also beneficial. Dietary control of fat intake and treatment of high lipid levels by specific drugs may also be necessary for such patients.
What are things that are to be kept in mind in diabetic kidney disease?
- Cardiovascular Health-Diabetes causes inflammation of both large and small vessels of the body. Involvement of arteries of the heart is also very common, a condition known as coronary artery disease. It may lead to Chest pain or worse heart attack. Patients with diabetic kidney disease also need to be evaluated for these diseases.
- Eye Health-Diabetic retinopathy is one of the leading causes of blindness which is preventable. The retina of our eyes has small vessels which are commonly involved in such patients and they should be periodically evaluated with Fundoscopy.
- Nervous system-Diabetic kidney disease patients can have involvement of the Brain in the form of increased risk of strokes and also peripheral nerves; these may lead to loss of mobility of the patients.
- Vaccination-Diabetes with prolonged hyperglycemia can decrease a person’s immunity and they are at higher risk of morbidity and mortality with common infections like Hepatitis, Influenza, COVID 19, and Pneumococcus (a type of lung infection). They should be vaccinated against these diseases promptly.
