How diabetes affects the kidneys

Diabetic nephropathy (DN) is the commonest form of kidney disease in adults, accounting for almost half the patients in any dialysis programme. Sometimes, it takes weeks or even months for symptoms to become prevalent. Early detection and proper treatment can often keep chronic kidney disease from getting worse, and prevent the need for dialysis or a transplant and also premature death.

The only response to this health and socio-economic crisis is its prevention.

What happens in chronic kidney diseases?

*Loss of appetite, nausea and vomiting

*Constant fatigue and weakness (from anaemia or accumulation of waste products in the body)

*Swelling of the legs and puffiness around the eyes (fluid retention)

*Itching, easy bruising and pale skin (from anaemia)

*Headaches, numbness in the feet or hands (peripheral neuropathy), disturbed sleep, altered mental status (encephalopathy from the accumulation of waste products or uremic poisons), and restless legs syndrome

*High blood pressure, chest pain due to pericarditis (inflammation around the heart)

*Shortness of breath from fluid in lungs

How can one detect diabetic nephropathy?

The earliest detectable change in the course of diabetic nephropathy is a thickening in the glomerulus (glomerulus is a cluster of capillaries which perform the first step in filtering blood to form urine). At this stage, the kidney may start excreting more serum albumin (plasma protein) than normal. This stage is called microalbuminuria.

There is also marked day-to-day variability in albumin excretion, so at least two of three collections done in a 3- to 6-month period should show elevated levels before a patient is designated as having microalbuminuria.

A test for the presence of microalbumin should be performed at diagnosis of diabetes in all patients with type 2 diabetes.

Microalbuminuria rarely occurs with short duration of type 1 diabetes; therefore, screening in individuals with type 1 diabetes should begin after 5 years of diagnosis although, at this stage the kidney’s filtration function usually remains normal and there are no symptoms.

How can one prevent chronic kidney diseases if he/she has diabetes?

The seven golden rules for prevention of chronic kidney disease are:

*Blood pressure should be maintained at
*It is also very important to control lipid levels, maintain a healthy weight, and engage in regular physical activity.

*Smoking needs to be stopped.

*Microalbuminuria should be checked annually. This allows the identification of patients with nephropathy at a point very early in its course. Improving glycemic control, aggressive antihypertensive treatment, and the use of ACE inhibitors or ARBs slow the rate of progression of nephropathy.

*Take care of bladder or urinary tract infections and treat them early.

* Don’t take any new medications without first consulting  your doctor. This includes over-the-counter drugs, vitamins and herbal supplements.

*Don’t miss your appointments with the doctor.

As kidney failure progresses, lesser and lesser insulin is excreted, so smaller doses may be needed to control glucose levels. Dialysis may be necessary once end-stage kidney disease develops.

At this stage, a kidney transplant may be considered. Another option for patients with type 1 diabetes is a combined kidney-pancreas transplant.

However though 20-40 percent of those with diabetes develop kidney disease, it can be slowed significantly if diagnosed early and treated.

Intensive management of blood glucose has shown great promise for people with diabetes, especially for those in the early stages of diabetic nephropathy.

The regimen includes testing blood glucose frequently, taking medicines or insulin as prescribed to keep HbA1c less than 7, performing physical activity, following a diet and activity plan, and consulting a healthcare team regularly.