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Dr Mayank Uppal explains Diabetes and kidney problems


Kidney disease is primarily brought on by diabetes. Kidney disease affects about 1 in 3 persons who have diabetes. The kidneys’ primary function is to remove wastes and surplus water from the blood through urine. Additionally, the kidneys produce the hormones the body requires to maintain health and regulate blood pressure.1

Diabetes damages tiny blood vessels in the kidneys, and the kidneys cannot effectively clean blood. As a result, unhealthy levels of water and salt is accumulated in the body, which may lead to weight gain and ankle swelling. The urine might contain protein. Additionally, waste products will accumulate in the body.

Diabetes also may cause damage to nerves in the body. This can cause difficulty in emptying the bladder. The pressure resulting from a full bladder can put pressure on the kidneys. Also, in uncontrolled diabetes, if urine remains in the bladder for a long time, the sugar content in the urine makes the urinary system prone to the growth of bacteria – urinary tract infections become more common.2

Around 20 to 30% of people with diabetes develop kidney disease (diabetic nephropathy), although not all of these will progress to kidney failure. A person with diabetes is susceptible to nephropathy whether they use insulin or not. The risk is related to the duration of diabetes – prolonged diabetes is bad for the kidney.

People with diabetes are also at risk of other kidney problems, including narrowing of the arteries to the kidneys, called renal artery stenosis or renovascular disease.

Signs of kidney disease in people with diabetes3

As the kidneys fail, blood urea nitrogen levels will rise as well as the level of creatinine in the blood; these can be observed on a blood test. Other Symptoms include:

  1. Nausea, vomiting, and/ or a loss of appetite
  2. Weakness and increasing fatigue
  3. Itching
  4. Muscle cramps (especially in the legs)
  5. Anemia (low hemoglobin levels)

Risk Reduction Approaches3

There are several ways that a person with diabetes might lower their risk of developing diabetic nephropathy or at least postpone it, including:

  1. Managing blood sugar levels strictly
  2. Ensuring that blood pressure is properly managed
  3. Staying away from non-steroidal anti-inflammatory medications (NSAIDs), which are commonly used in pain
  4. Rapid antibiotic treatment for urinary tract infections
  5. Drinking a lot of water or other non-alcoholic beverages
  6. Avoiding medical procedures, such as x-rays requiring the injection of contrast dyes, that put a strain on the kidneys
  7. Having frequent tests to make sure kidneys are healthy.

Unfortunately, there is no cure for diabetic kidney disease, and treatment is lifelong. Chronic kidney disease (CKD) often develops slowly and with few symptoms. Many people don’t realize they have CKD until it’s advanced and need dialysis (a treatment that filters the blood) or a kidney transplant to survive.4 Regular testing increases the chance of identification of CKD early. Early treatment is most effective and can help prevent additional health problems.

References:

Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States, 2019. Atlanta, GA: US Department of Health and Human Services. Centers for Disease Control and Prevention; 2019. https://www.cdc.gov/kidneydisease/publications-resources/ckd-national-facts.html

National Kidney Foundation, 2015. https://www.kidney.org/atoz/content/diabetes

Diabetes and kidney failure, Better Health Channel,  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/diabetes-and-kidney-failure

Prevention and Risk Management, Centers for Disease Control and Prevention, July 12, 2022. https://www.cdc.gov/kidneydisease/prevention-risk.html

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