Safeguard Your Kidney in Diabetes
Our kidneys play an important role in managing the level of water, salt and other minerals in the body. The kidneys filter blood and remove waste and excessive elements to maintain water and electrolyte balance in the body. Our kidneys consist of small units of nephrons which filter the waste and excess minerals from the blood. Diabetes or high blood sugar levels can scar and thicken the nephrons. This causes the nephrons to release a protein called albumin in the blood. Creatinine is a waste product filtered by the kidney from the blood. It is then sent to the urinary bladder to be eliminated through urine.
Kidney functioning
Kidney functioning is assessed by measuring the level of serum creatinine present in the blood. The estimated glomerular filtration rate (eGFR) is a test recommended to measure the filtration rate of the kidney. It is also used to check the stages of kidney damage. The test measures the level of serum creatinine present in the blood and provides an insight into the functioning of the kidney.
| Stage | eGFR range
(in mL/min/1.73m2) |
Interpretation |
| Stage 1 | 90 or above | Very mild damage to the kidneys but functioning is still at a normal level |
| Stage 2 | 89 to 60 | The damage has mildly increased and functioning has slightly reduced |
| Stage 3 | 59 to 30 | The functioning of the kidney is significantly reduced and may lead to other health problems |
| Stage 4 | 29 to 15 | Severe kidney dysfunction |
| Stage 5 | 15 or less | The occurrence of kidney failure. Dialysis may be required to manage health. A kidney transplant may also be recommended at this stage |
Diabetic nephropathy explained
Diabetic nephropathy is a kidney complication associated with Diabetes. High or uncontrolled blood sugar levels may affect the capacity of the kidney to filter waste and excess minerals from the body. This leads to a presence of high creatinine levels in the body. Research studies have shown that nearly 40 per cent of people with Diabetes develop kidney failure due to uncontrolled blood sugar levels.
A person with Diabetes and whose kidney filtration level is below 60 mL/min/1.73m2 is diagnosed with diabetic nephropathy and may require further assessment to check the level of functioning of the kidney. Risk factors of diabetic nephropathy include uncontrolled blood sugar levels, a long duration of Diabetes, high blood pressure, high cholesterol level, obesity, smoking, other Diabetes related conditions such as eye problems, nerve damage and heart disease and a family history of kidney disease and Diabetes.
Kidney disease explained
Kidney disease refers to a gradual loss of functioning of the kidney. In kidney disease, the filtration rate of the kidney is reduced and the level of waste, water and minerals rises in the body. This leads to swelling in the kidneys and may also scar the organ tissue. This in turn releases protein in the urine and may lead to other complications.
The symptoms of kidney disease generally do not appear at an early stage and manifest only after 40 per cent of the kidney is affected. Thus, it is important to assess the functioning of the kidney as soon as the symptoms are seen in order to diagnose the extent of the damage and to monitor its progression.
Symptoms
The symptoms of kidney disease generally do not appear in the initial stage and are visible only after the damage has progressed. Changes in the blood pressure and urine output may be the early signs of kidney dysfunction. Some of the symptoms seen in the advanced stages of kidney disease are:
- Swollen ankles, feet and hands due to water retention
- Dark urine
- Loss of appetite
- Dry and itching skin
- Nausea or vomiting
- Fatigue
- Reduced concentration levels
Diagnosis
A person who has had Diabetes for more than five years is advised to undergo testing for diabetic nephropathy. Blood and urine tests may provide information regarding the functioning of the kidney and the extent of kidney damage.
Urine albumin test is recommended to check the level of albumin present in the urine. Albumin is a protein present in the kidney and is released by the organ when scarred or swollen. The normal amount of protein albumin in the urine should be less than 20 mg/day. A urine albumin level of 30-300mg/day is termed as microalbuminuria or a little presence of albumin in the urine. A presence of more than 300mg/day of albumin in the urine is called as macroalbuminuria and may indicate diabetic nephropathy.
Along with albumin test, serum creatinine test is recommended to assess the filtration of the kidney. The normal range of serum creatinine for men is 0.9 to 1.3 mg/dL and for women is 0.6 to 1.1 mg/dL between the age of 18 and 60 years. High creatinine levels in the blood show reduced filtration rate and impaired kidney function.
Other diagnostic tests include kidney biopsy and blood urea nitrogen tests that can help in evaluating the level of damage to the kidney.
Complications
Kidney disease due to Diabetes develops over time and may lead to several complications in the body. These include:
- High potassium level
- High blood pressure
- Heart disease and stroke
- Fluid retention in the body
- Kidney failure leading to dialysis
- Retina damage
- Foot complications due to nerve damage
Management of diabetic nephropathy
Currently, there is no cure for diabetic nephropathy but the progression of kidney damage can be slowed by managing blood sugar levels. HbA1c level should be maintained below 7 per cent and if possible, below 6.5 per cent.
Hypertension or blood pressure above 140/90 mm Hg leads to a decline in kidney function. Higher the blood pressure faster will be the decline in kidney functioning. Maintaining blood pressure below 140/90 mm Hg slows the decline of kidney function. Maintaining both HDL (good) cholesterol and LDL (bad) cholesterol levels is also important.
Many drugs are able to manage blood pressure and reduce protein output in the urine. These drugs help reduce kidney scarring and may also improve kidney functioning. Diabetes medication lowers blood sugar level and protects kidney functioning.
A well-balanced diet in moderation with carbohydrates, fat, salt and sugar helps in maintaining health. Consumption of tobacco and alcohol should be avoided. Regular exercise and regular monitoring of blood pressure and blood sugar level are recommended.
A person with severe kidney damage may be recommended dialysis or kidney transplant to substitute kidney functioning in the body. Dialysis is a procedure in which the blood is passed through a dialysis machine to extract waste and the purified blood is transported back to the body.
Regular screening for the heart, eyes, feet and the kidneys may help prevent the development of complications in Diabetes. Along with this, maintaining blood sugar level, blood pressure and cholesterol levels may help reduce the pressure on the kidney. Annual blood testing helps to assess complications at an early stage and prevent their progression through diet, medication and exercise.
For more information about Diabetology, safety procedures, and treatment visit our website www.cdi.org.in