Dr. Sanjeev Gulati  (Director Nephrology),

Fortis Institute of Renal Science & Transplant MD, DNB(PGI, CHD), DNB, DM(Nephro), FIPN(Australia), FICN(Canada), FRCPC MNAMS, FIAP, FISN
+91-98716-00885   mail@kidneyklinic.com

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Diabetic Kidney Disease - Prevention is better than Cure


There is an an increasing prevalence of kidney disease all around the world and also in our country. Over the last 2 decades India has emerged as the country with the fastest growing patients with Diabetes in terms of numbers. Correspondingly Diabetes had emerged as the commonest cause of irreversible kidney disease or chronic kidney disease (CKD) in our country.

What do Kidneys do?
Most people know that a major function of the kidneys is to remove waste products and excess fluid from the body. These waste products and excess fluid are removed through the urine. This process is necessary to maintain a stable balance of body chemicals. The critical regulation of the body's salt, potassium and acid content is performed by the kidneys. The kidneys also produce hormones that affect the function of other organs. For example, a hormone produced by the kidneys stimulates red blood cell production. Other hormones produced by the kidneys help regulate blood pressure and control calcium metabolism.

The kidneys are powerful chemical factories that perform the following functions:

  • remove waste products from the body
  • remove drugs form the body
  • balance the body's fluids
  • release hormones that regulate blood pressure
  • produce an active form of vitamin D that promotes strong, healthy bones
  • control the production of red blood cells

What is Chronic Kidney Disease (CKD)?

Chronic kidney disease includes conditions that damage your kidneys and decrease their ability to keep you healthy by doing the jobs listed above. If kidney disease gets worse, wastes can build to high levels in your blood and make you feel sick. You may develop complications like high blood pressure, anemia (low blood count), weak bones, poor nutritional health and nerve damage. Also, kidney disease increases your risk of having heart and blood vessel disease.

Who are the people at high risk of Chronic Kidney Disease ?
Any Diabetic patient one can get chronic kidney disease. Several studies have shown that 1 in every 2 diabetic patients will end up with CKD. However, some people are more likely than others to develop kidney disease. You may have an increased risk for kidney disease if you:

  • Have diabetes
  • Have high blood pressure
  • Smoker
  • Have a family history of diabetic kidney disease
  • Have microalbuminuria

What are the symptoms of CKD?
You should not wait for symtoms to appear as most people may not have any severe symptoms until their kidney disease is advanced. The earliest isgn of diabetic kidney disease is appearance of micoalbbuminuria. i.e leakge of small amounts of protein in urine . Another sign of presence of underlying kidney damage is the appearance of retinopathy or diabetic changes in the eye. However, you may notice that youfeel more tired and have less energy have trouble concentrating

  • Have a poor appetite
  • Have trouble sleeping
  • Have muscle cramping at night
  • Have swollen feet OR puffiness around your eyes, especially in the morning
  • Have dry, itchy skin
  • Need to urinate more often, especially at night

Is Diabetic Kidney Disease treatable?
An ounce of prevention is easier (and cheaper) than a pound of cure. Nowheer does this apply more than in patients with Diabetes. Simple measures like good blood sugar control and blood pressure control can go a long way in preventing Diabetic Kidney Disease. Hence it is mandatory to see your Diabetologist periodically and ensure your blood sugars are under good control.

How to make an early Diagnosis of CKD in Diabetic patients?
Dianosis of Kidney disease in diabetis individuals can be done by using very cheap and simple tests like urine for microablbuminuria and eGFR (estimated GFR). We should not wait for symptoms to appear .It is recommended that all diabetic patients should get their urine microalbuminuria estimations done every 6 months. Besides eGFR (estimated GFR) estimation should be done in all these patients, rather than relying on the traditional blood urea and serum creatinine estimation. These blood test detect kidney disease only when the kidney damage exceeds 60 % .i.e they are not helpful in early diagnosis of CKD.

Is Diabetic Kidney Disease treatable?
Yes if diagnosed early, Diabetic kidney disease can be treated very effectively and that too at a minimal cost. All diabetic patients with microalbuminuria should also see a nephrologist. First and foremost these patients should have meticulous blood sugar and blood pressure control. Anti proteinuric drugs like ACE inhibitors and angiotensin receptor blockers are very effective in reducing proteinuria as weel as controlling blood pressure. There is also an emerging role of uric acid lowering agents like allopurinol and febuxostat. Most importantly you should avoid pain killers, certain antibiotics and exposure to contrast media ( as in CT scna or angiography) Thes simple measures can prolong the life of kidneys very effectively and that too at a minimal cost.

In advanced kidney disease ( eGFR < 15%) kidney transplant and dialysis are very effective modalities. The outcomes of kidney transplant have improved tremendously over the last decade and all patients of Stage 5 Diabetic kidney disease should paln for a kidney transplant unless there are specific contraindications. Hemodialysis and Continuous Ambulatory Peritoneal Dialysis are two other effective options in patients who are waiting for kidney transplant or thssoe in whom adonor is not available.

Hence it is important for people who have diabetes should be screened for kidney disease and get thoer kidney function (eGFR) checked. An early diagnosis and prompt treatment can help avoid dialysis and transplantation or prolong the life of the kidneys and delay the need for the same.