How Does Diabetes Affect Your Kidneys?

World Diabetes Day is celebrated annually on November 14. Led by the International Diabetes Federation (IDF), World Diabetes Day was created in 1991 by IDF and the World Health Organization in response to growing concerns about the escalating health threat posed by diabetes.

Diabetes mellitus affects more than 7 crore people in India. The average age of onset is around 42.5 years.Nearly 50% of individuals with this condition remain unaware of their diagnosis.Diabetes mellitus is of two types- type 1 and type 2. Type 1 diabetes affects younger people with lean body mass whereas type 2 diabetes affects middle aged and older people who are overweight or obese. The increasing incidence of type 2 diabetes is attributed to a combination of genetic susceptibility plus adoption of a high-calorie, low-activity lifestyle by India's growing middle class.

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Poorly controlled diabetes mellitus leads to multiple complications affecting many organs of the body. It can cause damage to eyes leading to blindness (retinopathy), burning pain in hands and legs(neuropathy), damage to kidneys (nephropathy), blockage of blood vessels in the heart (coronary artery disease) and legs and strokes.

Diabetic nephropathy is one of the leading causes of kidney failure in many parts of the world including India. Prevention and early detection of diabetic nephropathy improves patient outcomes.To prevent diabetic kidney disease, every patient should ensure tight control of blood sugars. Fasting (empty stomach) and post prandial (after meal) blood sugars should be checked on a regular basis. A blood test (Haemoglobin A1C) performed once every three months gives an estimate of the blood sugar control in the last quarter. Target value for this test should be < 7.0 g/dL.

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Diabetes damages the filtration unit of the kidneys. This can be picked up in its early stages using a urine test detecting spillage of protein (albumin) in the urine. Testing for microalbuminuria (protein leakage in very small amounts)can identify diabetic individuals at higher risk of developing more proteinuria and risk of chronic kidney disease in the future.It is recommended for all diabetic patients to get this urine test done at least once a year, when there is no obvious damage to the kidney.

Another matter of utmost importance is good blood pressure control. Poorly controlled blood pressures accelerate the damage to the kidneys. Most guidelines recommend targeting a blood pressure of less than 130 / 80 mmHg. Medicines of the class ACE inhibitors or angiotensin receptor blockers should preferably be used whenever possible as they have been proven to slow down the rate of progression of diabetic kidney disease in patients with high blood pressure and urinary protein leakage.

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Because diabetes is associated with increased risk for heart attacks and strokes, treatment of high cholesterol and other lipids should not be underestimated. Medications to reduce the blood lipid abnormalities have been shown to delay the onset of heart disease. Diet and lifestyle modifications, including physical activity and weight reduction remain the most important factors for one's overall health. Smoking cessation can significantly lower the incidence of heart attacks and strokes.

Last but not the least, if you have been found to have damage to your kidneys from diabetes, do not forget to visit your friendly neighbourhood nephrologist!

(By: Dr. Dinesh Khullar, Chairman & Head of department Nephrology & Renal Transplant Medicine and Dr. Sagar Gupta, Associate consultant Nephrology & Renal Transplant Medicine.)