Diabetic kidney disease or the term commonly referred to as diabetic nephropathy is one of the long-term sequelae of diabetes.
Most patients with diabetic kidney disease do not experience symptoms until later stages.
Diabetes Mellitus is a chronic disease that occurs when the pancreas cannot produce enough insulin or when the body cannot effectively use the insulin it produces. Patients with uncontrolled diabetes over time suffer serious damage to many organ systems, including the heart, eyes, kidneys, nerves and blood vessels.
Diabetes has reached epidemic proportions in recent decades worldwide. Diabetic kidney disease or the term commonly referred to as diabetic nephropathy is one of the long-term sequelae of diabetes. More than 1 in 3 adults with diabetes will develop some form of diabetic kidney disease in their lifetime.
Over many years, high blood sugar slowly damages the kidneys’ filtering system along with the blood vessels. This leads to diabetic chronic kidney disease (CKD). Chronic kidney disease is usually a slowly progressive disease and is categorized into five stages based on the estimated glomerular filtration rate (eGFR), which reflects the overall functioning of the kidneys. If left unchecked, chronic kidney disease leads to permanent kidney damage and few patients reach end-stage kidney disease or stage 5 chronic kidney disease (ESRD) where they need dialysis for life support.
Diabetic kidney disease is considered a silent killer as most patients do not experience symptoms until the later stages when there is significant damage to the kidneys.
Risk factors for chronic kidney disease include:
1) Uncontrolled sugars and BP over a long period of time
2) Obesity, sedentary lifestyle along with eating habits containing high carbohydrate and high salt content
3) Chronic consumption of analgesics and smoking
Early diagnosis and treatment can prevent or slow the progression of the disease and reduce the chance of complications.
In patients with type 1 diabetes, evaluation for renal involvement should begin 5 years after diagnosis, but in patients with type 2 diabetes, evaluation for kidney disease should begin at diagnosis. This is important because type 2 diabetes can go undetected for long periods of time and significant kidney disease can be present at the time of diagnosis.
The first test that can detect diabetic kidney disease is the presence of protein in the urine. Normally functioning kidneys do not allow the passage of albumin in the urine, and finding albumin in the urine is a marker of kidney disease. This test can become abnormal even when blood markers of kidney function are normal. The recommended test is the “Urine Creatinine Albumin Level” and this test is used to diagnose and monitor diabetic kidney disease over time. Blood tests for kidney function include blood urea nitrogen, creatinine, and electrolytes such as sodium, potassium, and calcium.
Once a patient has been detected to have diabetic kidney disease, he or she should undergo regular follow-up with the nephrologist (kidney specialist) along with their primary physician.
Symptoms of progression of chronic kidney disease include decreased urine output with fluid retention, swelling in the feet and face, shortness of breath, anemia and high blood pressure.
To reduce the risk of progression of diabetic nephropathy, blood sugar and BP should be monitored and controlled regularly. Lifestyle modifications include exercise, adequate hydration, not smoking, and dietary restrictions such as low carbohydrate and salt intake. Intake of analgesics should only be done under the guidance of a nephrologist in patients with diabetic kidney disease.
(Dr. Saurabh Pokhariyal, Head of Department and Consultant – Nephrology, HMCCT Manipal Hospitals, Dwarka)
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