Kidney caution

Diabetes can be controlled but watch out for other health problems it can cause.

Have you recently found out that you are a diabetic and are you concerned about the gamut of health issues it can pose? Diabetes is a common lifestyle disorder that can cause a number of serious health complications that can prove life threatening.

People with diabetes are at the risk of heart attacks, strokes, vision loss, nerve damage, and kidney disease. Watch out also for diabetic nephropathy. While all of these ailments may sound overwhelming, there is some respite, as taking steps to avoid even one of these complications may actually help to prevent them all.

Kidneys play an important role in our body, by filtering the blood and removing waste and ejecting excess salt and water. Diabetes can affect the functioning of your kidneys causing them to falter in their task, and leaving the blood polluted.

Getting tested for diabetic nephropathy in the early stages can alert you if your kidneys are in danger. In some cases, diabetic nephropathy can eventually cause the kidneys to stop working altogether. Kidney transplant and dialysis are the only options in extreme cases.

The symptoms
There are hardly any obvious symptoms to this disease in the early stages, as a patient’s urine output is often normal. To detect diabetic nephropathy, doctors rely on tests that measure protein levels in the urine and blood tests to evaluate the level of kidney function.

When the kidneys work normally, they prevent protein from leaking into the urine. So finding protein in the urine is a sign of malfunction. Often people who have diabetic nephropathy also have high blood pressure.

Having a family history of kidney disease can increase your risk of developing diabetic nephropathy. Although you cannot change genetics, you can always prevent the disorder by controlling other risk factors that include:

Chronically elevated blood sugar levels
Obesity
Smoking
Diabetes-related vision problems (diabetic retinopathy) or nerve damage (diabetic neuropathy)
Stay aware
Urine tests are recommended once a year in people with Type 1 diabetes, beginning about five years after diagnosis, and in people with Type 2 diabetes, starting at the time of diagnosis. The urine tests are conducted to detect the presence of a protein called albumin. A large amount of albumin in your urine can be ascribed to diabetic nephropathy.

It’s complicated
The key complication of diabetic nephropathy is a more advanced kidney disorder, called chronic kidney disease. This can progress even further, eventually leading to total kidney failure, which can only be cured by dialysis or a kidney transplant.
People with diabetes often focus on keeping their blood sugar levels in the right range. And while it is important to control blood sugar, it turns out that controlling blood pressure is also as crucial. High blood sugar and high blood pressure can together damage the blood vessels and organ systems.

Here are some important steps you need to take to stall kidney disease and other complications caused by diabetes:

Make lifestyle changes: A healthy lifestyle translates to healthy kidneys. It is recommended that one must limit the amount of salt consumption, quit smoking and lose weight.

Manage your blood sugar level: Keeping your blood sugar close to normal can help prevent the long-term complications of diabetes mellitus. For most people, a target for fasting blood glucose and for blood glucose levels before each meal is 80 to 120 mg/dL.

Manage blood pressure: Often people suffering from diabetes also have hypertension. Although high blood pressure causes a few symptoms, it has two negative effects — it stresses the cardiovascular system and speeds up the development of diabetic complications of the kidneys and eyes.

The treatment of high blood pressure varies. If you have mild hypertension, weight loss, exercise, reducing salt consumption, cutting down on smoking and alcohol intake are recommended. A blood pressure reading below 140/90 is the recommended goal for most people with diabetic nephropathy, but a blood pressure reading below 130/80 is suggested for many who have more than 300 mg of albumin in their urine per day.

Most people with diabetic nephropathy need at least one medication to lower their blood pressure. Angiotensin-converting enzyme inhibitor or a related drug known as an angiotensin receptor blocker are commonly prescribed.

Pregnancy pointers
If you are suffering from diabetic nephropathy and are keen on getting pregnant, it is important to consult a doctor. Diabetes and its attendant problems can increase the risk of complications in pregnancy, especially in women with decreased kidney function. However, many women with mild diabetic nephropathy have normal pregnancies and healthy babies.

To ensure the best outcome with a pregnancy, the most important thing you can do is to keep your blood sugar and blood pressure under control. However, women who are pregnant or trying to get pregnant should not take angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, as these drugs can cause birth defects.

(Dr Venu Madhav Reddy G, consultant — nephrology & Dr C V Harinarayan, director — diabetes & endocrinology, Sakra World Hospital.)