Diabetes Mellitus is a chronic health condition which can affect people of any age and sex. It is prevalent in rural and urban areas of both developing and non-developing countries. In the United States, the estimated number of people over 18 years of age with diagnosed and undiagnosed Diabetes is 30.2 million. The figure represents between 27.9% and 32.7% of the population. The estimated prevalence of Type 2 Diabetes Mellitus in Pakistan is around 11.77%. Diabetes is a disease of the blood vessels which can involve any organ in the body, including the kidneys.
When the kidneys are affected by Diabetes, it is called Diabetic Kidney Disease, which is a serious kidney-related complication. About 25% of people with Diabetes eventually develop kidney disease. It affects the kidneys' ability to work properly. It is a progressive disease which affects kidneys to the extent that End Stage Renal Failure happens. End Stage Renal Failure requires dialysis or kidney transplants to sustain life. Diabetic Kidney Disease progresses through five stages. The first and second are usually missed because of a lack of symptoms. The third stage is the presence of a small amount of protein in the urine called Microalbuminuria. This small amount of protein in the urine is not detected by a routine dip stick urine analysis test. The specific urine test for Microalbumin is recommended. This is quite important as this stage is reversible with treatment, hence can delay the development of Diabetic Kidney Disease.
In the early stages of Diabetic Nephropathy, one may not have any signs or symptoms. In later stages, development of or worsening blood pressure control, swelling of feet, ankles, hands or eyes, increased need to pass urine, reduced need for insulin or diabetes medicine, confusion or difficulty concentrating and fatigue occurs. With advancement in kidney involvement and development of kidney failure, one can experience shortness of breath, loss of appetite, nausea, vomiting, persistent itching and weakness.
People who have poorly controlled diabetes, poorly controlled high blood pressure, a family history of Diabetes and Kidney Disease, and who take tobacco in any form (cigarettes, cigars, chewing tobacco, huqqa, paan, etc.) are at increased risk of developing Diabetic Kidney Disease.
In order to reduce the risk of developing Diabetic Kidney Disease, there are certain important factors. Good control of Diabetes is the key to success. The recommended HBA1C level is 6.5 – 7. Diet, medication and regular check-ups with a Diabetologist are recommended. Good control of high blood pressure is also important – the recommended blood pressure level is 130/90 or less. It can be controlled via diet and medication. It is important to remember that some people need one medication while others need four, so the importance is to ensure good control regardless of the number of pills. Quit smoking and tobacco intake. Avoid painkillers like diclofenac, ibuprofen, mefenamic acid. Maintain a healthy weight. Quit smoking and tobacco intake in any form. Practice a healthy lifestyle.
Diabetic Kidney Disease is detected earliest by a urine lab test for Microalbuminuria. Later, a spot urine Protein to Creatinine Ratio (PCR) or Albumin to Creatinine Ratio (ACR) and Serum Creatinine are important lab tests for the detection of kidney involvement in Diabetes. These should be done yearly. As early as kidney involvement is detected by any of these tests, immediate contact with nephrologist should be made, so steps can be taken to reverse or slow down the progression of kidney damage. The nephrologist may modify your medications at this stage. Early detection of kidney involvement is quite important to reverse or stabilize the disease. Once kidney damage is established, chances of reversal decreases. Progression to End Stage Renal Failure become inevitable. Diabetes, High Blood Pressure and Chronic Kidney Disease are called silent killers because people don't have many symptoms till it is too late. It is best to ensure regular check-ups.
On World Diabetes Day, a message from Nephrologists is ‘protect your kidneys through good control of your Diabetes'. Healthy kidneys, healthy life, happy family.