Diabetic kidney disease causes kidney failure
02 Mar 2017 - 12:21
Diabetic kidney disease is the most common cause of kidney failure. One in five people on dialysis has diabetic kidney disease. Timely and proper treatment can prevent or delay the onset of this condition.
Kidneys filter out waste products from blood into urine. They also control blood pressure; synthesize hormones to make blood, and maintain the salt-water balance in the body. In diabetes, the kidney filters (glomeruli) get damaged, and leak protein from blood to urine, especially a major protein called albumin. A raised level of albumin in the urine is one of the first signs that the kidneys are damaged. Based on how much Albumin is lost in urine, diabetic kidney disease is divided into Microabluminuria (loss of 30-300mg/day) or Macroalbuminuria (loss more than 300mg/day).
Kidney damage in diabetes is mainly due to high blood sugar levels. This causes “scarring” of the kidney filters, called glomerulosclerosis slowly over time. The kidneys become less able to clean the blood eventually leading to kidney failure.
Microalbuminuria, if detected early and treated can be controlled in most, if not all patients. It is irreversible and proceeds to kidney failure.In early diabetic kidney disease, microalbuminuria can sometimes be the only symptom. In severe disease, symptoms like mental clouding, ankle and leg swelling, poor appetite, weight loss, dry itchy skin, muscle cramps, puffiness around eyes, and anemia may be seen.
Diagnosis is by measuring albumin levels in urine in diabetics. Other tests likealbumin:creatinine ratio (ACR), renal function values, andcalculated glomerular filtration rate (eGFR) may also be needed for a proper evaluation of the condition. The results are interpreted by a qualified physician.
Treatment delays the progression of the kidney damage. Lifestyle changes like quitting smoking, alcohol restriction, diet control, weight loss and regular physical activity help prevent disease progression.
Angiotensisn Converting Enzyme (ACE)inhibitors and angiotensin-II receptor blockers (ARB)are drugs used to treat high blood pressure. They also protect the kidneys and heart, helpingto prevent or delay the progression of the kidney andcardiovascular diseases.
An HbA1c of6.5% or less and a blood pressure of less than 130/80 mmHg are the optimal targets in treatment. Cholesterol levels must also be kept in control. Kidney damaging medicines must be avoided in these patients.
In spite of all efforts, if a progressive decline in renal function is seen, a kidney specialist must be consulted. If kidney function falls below a certain level,dialysis or a kidney transplant will be necessary.
Dr Deepak Chandramohan is an MBBS MD (Internal Med) Physician Internal Medicine, who works for Naseem Al Rabeeh Medical Center