Diabetic kidney disease or the commonly referred term as diabetic nephropathy is one of the long term sequelae of diabetes.
Most patients with diabetic kidney disease do not have symptoms until the later stages
Diabetes Mellitus is a chronic disease which occurs when the pancreas fails to produce sufficient insulin or when the body cannot effectively use the insulin it produces. Patients with uncontrolled diabetes over time experience serious damage to many organ systems including heart, eyes, kidney, nerves and blood vessels.
Diabetes has reached epidemic proportions over past few decades worldwide. Diabetic kidney disease or the commonly referred term as diabetic nephropathy is one of the long term sequelae of diabetes. Over 1 in 3 adults with diabetes will develop some form of diabetic kidney disease in their lifetime.
Over many years, high blood sugars slowly damages the kidneys filtering system along with the blood vessels. This leads to diabetic chronic kidney disease (CKD). Chronic kidney disease is generally a slowly progressive disease and is categorized into five stages which are based on the estimated glomerular filtration rate (eGFR) which reflects the overall functioning of kidneys . If unchecked, chronic kidney disease leads to permanent kidney damage and few of the patient reach the stage of end stage renal disease or chronic kidney disease stage 5 (ESRD) where they require dialysis for life support.
Diabetic kidney disease is referred to a silent killer as most patients do not have symptoms until the later stages when there is significant damage to kidneys.
Risk factors:
The risk factors for chronic kidney disease include:
1) Uncontrolled sugars and BP over a long period of time
2) Obesity, sedentary lifestyle along with dietary habits containing high carbohydrate and high salt
3) Chronic painkiller consumption and smoking
Diagnosis:
Early diagnosis and treatment may prevent or slow the disease's progress and reduce the chance of complications.
In patients with type-1 diabetes the evaluation for kidney involvement should start 5 years after diagnosis but in patients with type-2 diabetes the evaluation for kidney disease should start at the time of diagnosis. This is important because type-2 diabetes can remain undetected for long periods of time and significant kidney disease may be present by the time of diagnosis.
The earliest test which can detect diabetic kidney disease is the presence of protein in the urine. Normally functioning kidneys do not allow 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 the blood markers of kidney function are normal. The recommended test is "Urine albumin creatinine ratio" and this test is used to both diagnose and monitor diabetic kidney disease over time. The blood tests for kidney function include Blood urea, creatinine and electrolytes like sodium, potassium and calcium.
Management:
Once a patient is detected to have diabetic kidney disease, he/she should be in regular follow up with the nephrologist (kidney specialist) along with their primary physician.
The symptoms of progression of chronic kidney disease include decrease urine output with fluid retention, swelling over the feet and face, breathlessness, anemia and high BP recordings.
To reduce the risk of progression of diabetic nephropathy blood sugar and BP should be regularly monitored and controlled. Life style modifications include exercise, adequate hydration, no smoking and dietary restrictions like low carb and salt intake. Intake of pain medications should be only under the guidance of a nephrologist in patients with diabetic kidney disease.
(Dr. Saurabh Pokhariyal, Head of Department and consultant - Nephrology,HCMCT Manipal Hospitals, Dwarka)
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