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Importance Of Early Detection And Timely Management Of Diabetic Nephropathy

High blood sugar levels in diabetes can damage the small blood vessels and tiny filters in the kidneys.

Importance Of Early Detection And Timely Management Of Diabetic Nephropathy

A person with diabetes must regularly monitor their blood glucose levels

Diabetes is a significant health challenge in India with a high and growing prevalence. A recent study has highlighted that around 101 million people in India are living with diabetes. To put things into perspective, this is roughly 11.4 percent of India's population.

The disease is known to significantly impact most parts of the human body, including the heart, brain, eyes, kidneys, and liver in the form of cardiovascular diseases, retinopathy, kidney-disease, and fatty liver disease - these are conditions that we may have witnessed in our near ones with diabetes.

However, it is essential to know that diabetes gives rise to chronic kidney diseases, way before it manifests with symptoms and health-issues. Also known as diabetic nephropathy, it is a condition that affects individuals with type-1 or type-2 diabetes. It is caused by the high blood sugar levels in diabetes, which damage the small blood vessels and tiny filters in the kidneys. This results in progressive damage to the kidney structure and function, which often silently progresses over many years, and eventually gets recognized as kidney failure. Once the kidney disease reaches an advanced stage, the damage is not only irreversible, but also extremely difficult to manage in terms of morbidity, costs, quality of life, as well as the hanging sword of untimely death. It is noteworthy that since kidney disease often progress without any obvious signs or symptoms, its timely detection can be easily missed out. The importance of awareness and proactive vigilance for kidney disease in diabetes, cannot be emphasized enough!

Early signs of kidney disease

It is imperative that kidney disease be detected at an early stage, to better manage and prevent it from advancing to end-stage renal disease. Since chronic kidney disease is often silent in its early course, it is essential to get regularly checked for kidney disease, if you have diabetes. Assessment of kidney disease is usually done through a urine test, as well as a blood-test. Both these tests are essential to be performed and repeated at periodic basis, as guided by your doctor.

As the kidney damage progresses, it may lead to the occurrence of signs and/or symptoms. Tiredness and fatigue, increased frequency of urination, swelling in ankles and feet indicating fluid retention, are some manifestations of kidney disease. Importantly, kidney disease often results in high blood-pressure, and vice-versa. If you have high blood-pressure along with diabetes, then it is extremely important to optimally control your blood-pressure, along with the blood-glucose levels.

How to prevent or slow down the progression of chronic kidney disease in diabetes?

Glycemic control: The risk for chronic kidney disease increases with the duration of diabetes, particularly if the sugar-levels are not kept in check. A person with diabetes must regularly take the glucose-lowering medication and monitor the blood glucose levels, as advised by the doctor.

Controlling blood pressure: High blood pressure can also considerably contribute to the progression of kidney disease. One must keep the blood pressure in control by regularly taking the prescribed medication. Simultaneously, it is recommended that individuals stay away from situations of high stress, meditate, and maintain healthy lifestyle practices.

Controlling lipid levels: A deranged lipid profile, with high levels of bad cholesterol and triglycerides, accompanied by low levels of good cholesterol, is very common in people with diabetes. Poor control of lipid levels is also associated with increased risk of kidney disease, apart from its well-known association with the risks of heart-attack, stroke, or gangrene. Like blood-glucose as well as blood-pressure, the control of lipid levels forms the third key pillar for optimum diabetes care.

Regular checkups: The best way to ensure that you are protected from kidney disease in diabetes, is through timely testing. The evidence-based standards and guidelines for diabetes care across the world, recommend testing for chronic kidney disease at least once a year for people with diabetes. It is also recommended to get regular checks for blood pressure, lipid levels, and glucose levels. Getting it diagnosed early helps timely treatment and prevents chances of a barrage of possible health problems.

Dietary changes: Maintaining a healthy diet based on consultation with a proper dietician to ensure the body is getting the correct amount of nutrition is paramount. For the prevention of kidney disease, dieticians could recommend a diet rich in fruit, vegetables, fish, nuts, legumes, and healthy fats, such as olive oil.

The diet could, based on the patient's condition, ask them to reduce the intake of minerals like phosphorus (found in meats, beer, soda drinks, and chocolates), sodium (table salt), potassium (found in fruits like bananas and veggies like broccoli), and at times even protein (chicken, meat, fish). Staying true to the diet and tweaking components at regular intervals based on a dietician's recommendations should the patients keep meals interesting while ensuring that the body gets the right amounts of nourishment.

Lifestyle changes: A well-balanced diet works in tandem with a healthier lifestyle to ensure kidney health remains top-notch at all times. Optimum physical activity, as customized for each individual with diabetes by the healthcare provider, is a vital aspect of holistic care as well as prevention of complications like heart and kidney disease. Weight-loss is particularly important in people who are overweight or obese, not only for kidney-protection, but also for multiple cardio-renal-metabolic health benefits in people with diabetes.

One of the biggest changes it demands is quitting smoking and tobacco consumption as this is a common risk-factor for developing chronic kidney disease in diabetes.

Preventing and slowing the progression of diabetic kidney disease is key to leading a life free of health complications. Stringent control over diabetes, and blood pressure, and an active lifestyle are instrumental in preventing the occurrence and worsening of the condition.

(Dr. K.D. Modi is a Hyderabad-based Endocrinologist)

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