Kidneys act as our body’s filtration system and remove wastes and extra water from the body. The kidneys also help control blood pressure and make hormones that your body needs to stay healthy. Each kidney is made up of millions of small filters called nephrons. Recent estimates have shown that 77 million individuals have diabetes in India, which is expected to rise to over 134 million by 2045.
Diabetes is the leading cause for kidney disease worldwide. Approximately one in three adults with diabetes will develop diabetic kidney disease. Both type 1 and type 2 diabetes mellitus can cause kidney disease. With World Diabetes Day 2022 around the corner, OnlyMyHealth editorial team spoke to Dr. Atit Dharia ,Consultant Nephrologist, Masina Hospital, Byculla, Mumbai, to know about the link between kidney damage and diabetes.
Link between kidney damage and diabetes
Patients with uncontrolled blood sugar level have the highest risk of developing kidney disease due to diabetes. High blood glucose levels lead to increased filtration of glucose, which leads to increased workload on the kidneys. Long term uncontrolled diabetes can cause damage to small blood vessels in the kidney as well as damage to the nephrons. Diabetes can also damage the nerves to the urinary bladder, leading to problems with bladder control and function. Patients may not be able to feel when the bladder is full. The pressure from a full bladder can also damage the kidneys.
Patients with diabetes are also at increased risk of urinary tract infection and other infections that are also known to cause kidney injury. Hypertension with uncontrolled blood pressure is one of the most important predictors for diabetic patients to develop kidney disease. Diabetes mellitus is often associated with other diseases like obesity and cardiovascular disease, which are also linked with kidney diseases. Patients who have diabetes are more prone to kidney injury from nephrotoxic agents like common pain medications (Ibuprofen, Naproxen) and iodinated contrast agents. Finally, 20-40% patients with diabetes can have kidney disease unrelated to their diabetes status.
Symptoms of diabetic kidney disease
Most people with early stages of kidney disease do not have symptoms. The earliest sign of diabetic kidney disease is increased leakage of protein called albumin in the urine. Patients start developing symptoms of kidney disease like fatigue, ankle swelling, nausea, decreased appetite among many others in later stages of kidney disease when kidney function decreases to 20 to 40%. Some patients may notice a decrease in requirement of diabetes medicines or insulin dose which might be considered as improvement in diabetes control by the patients, actually it is an important sign to suggest kidney injury.
How to manage kidney damage?
To help in early detection of kidney disease in the patients with diabetes, annual check-up for kidney parameters and leakage of protein in the urine should be done in patients with type 2 diabetes from the time of diagnosis and in type 1 diabetes after five years of diagnosis. Once patients are diagnosed to have diabetic kidney disease, it cannot be cured. But doctors can use treatments to try and stabilise the kidneys which include:
1. Achieving target level of blood pressure and blood glucose will slow the kidney damage.
2. Use of specific classes of drugs like ACE-inhibitor/angiotensin receptor blockers and SGLT-2 inhibitors are known to delay the progression of diabetic kidney disease.
3. Regular blood check-up, urine examination and follow up with your doctor is important.
4. Avoid taking any nephrotoxic agents like pain medications. Always ask your doctor about an alternative medicine that can be taken.
5. Lifestyle changes: Healthy diet and getting 150 minutes of physical activity each week.
6. Any kidney disease will get worse rapidly by smoking, hence smoking cessation will help protect the kidneys.