Forbes India 15th Anniversary Special

Diabetic kidney problems

Dr. Madhu Shankar G, MD, D.M (Nephrology) (AIIMS),
Clinical Fellow (Toronto), Specialist in Clinical Hypertension (ASH), Consultant Nephrologist & Renal Transplant Physician

Published: Dec 7, 2022 05:10:17 PM IST
Updated: Dec 7, 2022 05:57:45 PM IST

Diabetic kidney problemsDiabetic kidney disease is a type of kidney disease caused by diabetes. Diabetes is the leading cause of kidney disease. About 1 out of 3 adults with diabetes have kidney disease. The main job of the kidneys is to filter wastes and extra water out of your blood to make urine. Your kidneys also help control blood pressure and make hormones that your body needs to stay healthy. When your kidneys are damaged, they can’t filter blood like they should, which can cause wastes to build up in your body. Kidney damage can also cause other health problems. Kidney damage caused by diabetes usually occurs slowly, over many years. You can take steps to protect your kidneys and to prevent or delay kidney damage.

Diabetes causing Kidney Disease
High blood glucose, also called blood sugar, can damage the blood vessels in your kidneys. With diabetes, the small blood vessels in the body are injured. When the blood vessels in the kidneys are injured, your kidneys cannot clean your blood properly. Your body will retain more water and salt than it should, which can result in weight gain and ankle swelling. You may have protein in your urine. Also, waste materials will build up in your blood.

Diabetes also may cause damage to nerves in your body. This can cause difficulty in emptying your bladder. The pressure resulting from your full bladder can back up and injure the kidneys. Also, if urine remains in your bladder for a long time, you can develop an infection from the rapid growth of bacteria in the urine that has a high sugar level.

Late Signs of Kidney Disease in People with Diabetes

As your kidneys fail, your blood urea nitrogen (BUN) levels will rise as well as the level of creatinine in your blood. You may also experience

  • Nausea, vomiting, and/ or a loss of appetite
  • Weakness and increasing fatigue
  • Itching
  • Muscle cramps (especially in your legs)
  • Anemia (a low blood count)

Other signs of kidney disease in people with diabetes include:

  • Albumin/protein in the urine
  • High blood pressure
  • Ankle and leg swelling, leg cramps
  • Going to the bathroom more often at night
  • High levels of BUN and creatinine in the blood
  • Less need for insulin or antidiabetic medications
  • Morning sickness, nausea, and vomiting
  • Weakness, paleness, and anemia
  • Itching

Early Signs of Kidney Disease in Patients with Diabetes
The earliest sign of diabetic kidney disease is increased excretion of albumin in the urine. This is present long before the usual tests done in your doctor's office show evidence of kidney disease, so it is important for you to have this test on a yearly basis. Weight gain and ankle swelling may occur. You will use the bathroom more at night. Your blood pressure may get too high. As a person with diabetes, you should have your blood, urine, and blood pressure checked at least once a year. This will lead to better control of your disease and early treatment of high blood pressure and kidney disease. Maintaining control of your diabetes can lower your risk of developing severe kidney disease.

Complications of diabetic kidney problems may develop gradually over months or years. They may include:

  • Fluid retention, which could lead to swelling in your arms and legs, high blood pressure, or fluid in your lungs (pulmonary edema)
  • A rise in potassium levels in your blood (hyperkalemia)
  • Heart and blood vessel disease (cardiovascular disease), which could lead to stroke
  • Damage to the blood vessels of the light-sensitive tissue at the back of the eye (diabetic retinopathy)
  • Reduced number of red blood cells to transport oxygen (anemia)
  • Foot sores, erectile dysfunction, diarrhea and other problems related to damaged nerves and blood vessels
  • Bone and mineral disorders due to the inability of the kidneys to maintain the right balance of calcium and phosphorus in the blood
  • Pregnancy complications that carry risks for the mother and the developing fetus
  • Irreversible damage to your kidneys (end-stage kidney disease), eventually needing either dialysis or a kidney transplant for survival

Prevention: Diabetic kidney problems

To reduce your risk of developing diabetic kidney problems:

  • Keep regular appointments for diabetes management. Keep annual appointments — or more-frequent appointments if recommended by your health care team — to monitor how well you are managing your diabetes and to screen for diabetic kidney problems and other complications.
  • Treat your diabetes. With effective treatment of diabetes, you may prevent or delay diabetic kidney problems.
  • Manage high blood pressure or other medical conditions. If you have high blood pressure or other conditions that increase your risk of kidney disease, work with your doctor to control them.
  • Follow instructions on over-the-counter medications. Follow instructions on the packages of non-prescription pain relievers. For people with diabetic kidney disease, taking these types of pain relievers can lead to kidney damage.
  • Maintain a healthy weight. If you're at a healthy weight, work to maintain it by being physically active most days of the week. If you need to lose weight, talk with your doctor about weight-loss strategies, such as increasing daily physical activity and consuming fewer calories.
  • Don’t smoke. Cigarette smoking can damage your kidneys and make existing kidney damage worse. If you’re a smoker, talk to your doctor about strategies for quitting smoking. Support groups, counseling and some medications can all help you to stop.

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