AR
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On the occasion of World Kidney Day, doctors have urged people to be aware of warning signs of diabetes, noting that it is the leading cause of impaired kidney function.
People living with diabetes are at risk of facing diabetic kidney disease. According to doctors, this condition is diabetic nephropathy which occurs when high blood pressure or high blood sugar from diabetes impact the kidneys.
Diabetes mellitus is the major cause of kidney disease in countries across the world. Unfortunately, at the time when Type 2 diabetes is diagnosed among people, approximately 7.5 percent of patients are already suffering from early diabetes-related kidney disease.
Just like the majority of the world, in the UAE as well, diabetes and hypertension have emerged as the biggest risk factors for kidney disease. Approximately 80 percent of kidney damage can be caused due to the two conditions.
What is diabetic nephropathy?
Dr Abeesh Padmanabha Pillai, Specialist Nephrologist – Lifecare Hospital, Musaffah, explains that if a diabetic patient has abnormal kidney function caused due to increase in albumin (protein) excretion in urine and reduced filtration function (glomerular filtration rate) of the kidney, they can suffer from diabetic kidney disease.
This kidney disease is diagnosed by measuring the albumin level in urine (also known as microalbuminuria) along with a blood test to assess the level of kidney function. These tests help in diagnosing kidney disease as well as monitoring the kidney status over a time period.
About 30 percent of patients with Type 1 (juvenile-onset) diabetes and 10 to 40 percent of patients with Type 2 (adult-onset) diabetes are at risk of suffering from kidney failure. Anu injury to blood vessels in the kidneys results in protein leak in urine, further causing weight gain and ankle swelling due to retention of water, salt and amines.
Dr John Cherian Varghese, Specialist Nephrologist, Aster Hospital and Aster Jubilee Medical Complex, noted that diabetes can also impact bladder emptying due to damage of the nerves.
“This can precipitate a rapid growth of bacteria in the urine that has high sugar levels, leading to urine infection," Dr Varghese added.
Long-standing diabetes, particularly uncontrolled, tends to damage small blood vessels in the kidneys. These are the basic functional sub-unit of the kidneys. It further results in the development of microvascular complications of diabetes.
Dr Sandeep Varma, Specialist Nephrologist, Prime Hospital, stated that the condition is usually associated with other microvascular complications such as diabetic retinopathy/neuropathy and is often accompanied by hypertension.
"Apart from classical diabetic nephropathy, diabetic people commonly have infection with secondary renal dysfunction, diabetic bladder with resultant kidney involvement secondary to urinary obstruction and kidney disease secondary to hypertension, which commonly coexist with diabetes," Dr Sandeep added.
After about 15 years of diabetes, about 20 percent to 30 percent of the patients develop microalbuminuria and about 50 percent of them are at risk of severe kidney disease during the course.
Dr Pillai noted that older age, low socioeconomic status, obesity, smoking, poor glycaemic and blood pressure control and genetic factors are some of the risk factors for diabetes-related kidney disease.
Dr Pillai explained that continuous uncontrolled blood sugar results in the formation of an abnormal compound called advanced glycation end-products (AGE) in the blood. With AGE, other factors such as resistance to insulin action, increased insulin levels and altered glomerular hemodynamics can potentially damage the filtering membranes of kidney (glomerular basement membrane). It makes them leakier, which further results in the formation of microalbuminuria in urine.
Over time, the filtration function of kidney (glomerular filtration rate) starts reducing which could lead to permanent kidney damage.
Dr Sandeep Varma, Specialist Nephrologist, Prime Hospital, says about 25 percent of all diabetics ccould develop diabetic kidney disease due to uncontrolled blood sugars, hypertension, obesity, smoking and frequent use of analgesics. These factors increase the risk and severity of kidney involvement with diabetes mellitus.
Symptoms
Patients are unlikely to notice signs or symptoms in the early stages of diabetic nephropathy. However, in the later stages, signs and symptoms can include deteriorating blood pressure control; protein in the urine; swelling of feet, ankles, hands, or eyes; increased urination; reduced need for insulin or diabetes medicine; difficulty in concentrating; shortness of breath; loss of appetite; nausea and vomiting; persistent itching, and fatigue.
Dr Prem Geovanni Johnson, Specialist Nephrology at Aster Hospital, Al Qusais, urged patients to visit their doctor if they notice any signs or symptoms of kidney disease.
“If you are living with diabetes, visit your doctor yearly or as recommended by the treating physician, for tests that measure kidney function at regular intervals," Dr Johnson added.
Managing the condition
While it is unlikely to reverse kidney damage due to diabetes, people can implement certain measures to prevent or delay complications. It is important for patients to take good care of their kidneys, particularly in the case of diabetes. Any damage can worsen over time due to more protein leaks into the urine. It can also result in elevated blood pressure and waste materials developing in the blood.
Dr Rajaram Jagdale, Specialist Nephrologist, Thumbay University Hospital, named high blood pressure as another sign of kidney problems. He further urged people to get it checked during every hospital visit to understand the normal levels. In addition, blood tests and urine tests can be conducted to gauge the levels of blood urea, protein and creatinine for further diagnosis.
Dr Jagdale stressed on eating healthier and ensuring regular exercise to improve overall blood glucose, blood pressure, and cholesterol levels. Doctors also recommended diabetic patients to cut down on protein, salt, and fat in their diet. They must also watch their alcohol intake, quit smoking and maintain good levels of water intake.
“One should also avoid taking too many painkillers, or using nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen on a routine basis as these can lead to kidney damage. Lastly, monitoring your blood glucose regularly at home is important," Dr Jagdale added.
Treatment
Studies have proved the benefits of medications used for blood pressure named angiotensin-converting enzyme (ACE) inhibitors and Angiotensin receptor blockers (ARB) in slowing down the loss of kidney function.
Furthermore, recent studies have also indicated the benefits of using an oral antidiabetic drug (SGLT2 inhibitors) to protect the kidney while controlling the sugars.
“The control of diabetes and preventing kidney complications will require a collective effort from the patient, his primary care physician, the nephrologist, a nutritionist and a physical trainer," Dr Varghese said.
Patients with diabetes and kidney disease are advised to reduce stress as it can negatively impact their ability to control the conditions.
The management plan may differ from patient to patient according to the stage of diabetic kidney disease. Dr Moamen Amin Abdelrahim, Consultant Urologist at Medcare Hospital Sharjah, suggested patients to stop the regression of renal functions in order to avoid kidney damage in the initial stage.
"After stabilisation, our target is to help the patient’s organs regain some of the lost functions. But we have to know that chronic kidney disease over months and years is usually irreversible. Acute cases occurring on top of chronic disease are correctable and reversible only if treated early and in the proper way," Dr Amin Abdelrahim noted.
He pointed out that in the first step to managing diabetes, patients must accept that they will need to live and cope with the disease throughout their lives.
“When we deal with it in a good way, it will be controlled without much suffering. We may have seen examples among our families and friends, of how normal life can be led if the condition is managed effectively," he added.
Dr Abdelrahim explained that diabetic kidney disease can get worse with time if proper care is not taken in terms of sugar levels, blood pressure, or cholesterol level. It is also significant to closely monitor kidney functions and follow the physician’s instructions regarding diet and lifestyle modifications.
“We are commonly discovering diabetic kidney disease accidentally on routine investigations for diabetes as the early stages are asymptomatic,” Abdelrahim added.
SOURCE: Gulf News