Understanding diabetic kidney disease

Do you know more than 76 million Indians suffer from diabetes? It means that 1 out of 6 people with diabetes in the world is from India. Clearly, the high incidence rate of this illness is alarming. However, what is even more startling is the serious complications diabetes can lead to, such as, diabetic kidney disease. 

Diabetic kidney disease (DKD) or diabetic nephropathy affects more than 25% of people living with diabetes. Despite such high figures, there is less light shed on the relationship between diabetes and kidney disease. 

In this article, Dr Mohit Khirbat, a leading nephrologist at the CK Birla Hospital, discusses everything you may need to know about diabetic kidney disease. 

What is diabetic kidney disease?

Before we begin to grasp an understanding between diabetes and kidney disease, let us learn what these illnesses mean, individually. 

Diabetes and kidney disease

Diabetes is a chronic illness in which the blood sugar levels in your body become too high. It is because your body is unable to make or use insulin (the chemical responsible for turning sugar into energy) in the intended way. There are two types of diabetes: type 1 and type 2. 

A kidney disease, on the other hand, is the inability of kidneys to function properly. Your kidneys are responsible for filtering the waste and extra fluids out of your blood. Kidney disease can cause waste to build up inside your body leading to kidney damage. 

Diabetic Nephropathy 

Diabetic nephropathy is among the top kidney disease complications of diabetes. It is a condition that leads to loss of kidney function in people suffering from diabetes. To put it simply, diabetic nephropathy is a kidney disease resulting from diabetes. This condition can occur in both type 1 and type 2 diabetic patients. 

What are diabetic kidney disease symptoms?

This ailment develops gradually over several years. It is possible to overlook diabetic kidney disease symptoms in its early stages. It is, thus, important to learn and track signs and symptoms reflecting diabetic kidney disease. 

• Worsening blood pressure control
• Presence of protein in the urine
• Swollen feet, ankles, hands or eyes
• Increase in the urge to urinate
• Decrease in the need for insulin or diabetes medicine
• Loss of appetite
• Difficulty concentrating
• Persistent itching
• Nausea and vomiting
• Fatigue
• Shortness of breath

Diabetic kidney disease symptoms can be detected early with the help of routine screenings and checkups. If you are living with type 1 or type 2 diabetes, you should regularly get tested for kidney disease. 

What are diabetic kidney disease stages?

As mentioned above, DMK progresses slowly over the years. Whether kidney disease is a result of diabetes or not, it is divided into 5 stages. Medical experts measure estimated glomerular filtration rate (e-GSR) to check the kidney function level and determine these stages. 

Stage 1: Normal kidney function 

Stage 2: Mild loss of kidney function 

Stage 3: Mild to a severe loss of kidney function

Stage 4: Severe loss of kidney function 

Stage 5: Kidney failure 

How does diabetes cause kidney disease?

Your kidneys are made up of millions of tiny blood vessel clusters. Uncontrolled or poorly controlled blood sugar levels can cause damage to these blood vessels. Diabetic kidney disease is caused when the damaged blood vessels lead to a decreased or complete loss of kidney function. 

Furthermore, damage to blood vessels can lead to high blood pressure. High blood pressure or hypertension can aggravate kidney function leading to kidney disease. 

While all diabetic patients are prone to developing diabetic nephropathy, some people have a higher likelihood than others. Common risk factors for diabetic kidney disease include:

• Poorly controlled high blood sugar
• Uncontrolled high blood pressure 
• Smoking
• High blood cholesterol
• A family history of diabetes and kidney disease

What is diabetic kidney disease diagnosis?

You should seek diabetic kidney disease diagnosis if you experience any of the above-given symptoms. A variety of tests are ordered to diagnose diabetic nephropathy. Your healthcare provider will determine the right types of tests based on your condition. 

Some of the most common tests recommended for this condition are:

• Blood tests: Blood tests are principal to determine the functioning of your kidneys. Blood tests help in monitoring your blood sugar levels.
• Urine tests: Microalbumin (a type of protein) in high levels can indicate kidney disease. Urine tests help to check the levels of protein in your urine. 
• Imaging tests: Several imaging tests such as X-rays, CT Scans, MRI are done to examine the structure and size of your kidneys. 
• Renal Function tests: As the name suggests, renal function tests are done to determine the functioning of your kidneys. Renal function testing includes a variety of tests that check the levels of different substances such as minerals, proteins, electrolytes and more. 
• Kidney biopsy: Doctors may recommend a kidney biopsy to closely examine the kidney for damage or disease. In a kidney biopsy, a small piece of your kidney is surgically removed and analysed under a microscope. 

What are diabetes and kidney disease treatment?

Diabetes and kidney disease treatment depends upon various factors such as the severity of your symptoms, your overall health and age. Medical experts determine which treatment protocol should be ideal for you. To treat diabetic nephropathy, your healthcare provider may first aim to manage your diabetes.  

Here are some diabetes and kidney disease treatment protocols:

• Medicinal therapy: The fine line of treatment for diabetic nephropathy is the medical management of your symptoms and the cause of the disease. Different medications are available to help manage your condition. 
• Hypertension: If your diabetic kidney disease is caused as a result of high blood pressure, your medical expert will offer medicines to control it. 
• Blood sugar levels: If you have uncontrolled diabetes i.e. high levels of blood sugar, you will be offered medicines to control that. 
• High Cholesterol: High cholesterol can be a serious factor leading to diabetic nephropathy. Your doctor will offer your medicines to lower your cholesterol levels in case you have high levels. 
• Protein in urine: Doctors may prescribe medication to lower the levels of protein in your urine. 

The medicinal approach is useful in patients who have mild diabetic nephropathy. If your condition is advanced or severe, you may be offered one of the following treatments: 

• Dialysis: Dialysis is a treatment method in which a machine is used to filter your blood and remove the waste and extra fluids. It is an effective method to manage severe kidney damage. Simply put, a dialysis machine performs the task of a damaged or diseased kidneys. Along with the treatment, you will be advised to follow a strict dialysis diet plan to avoid complications. 
• Kidney transplant: Kidney transplant is an invasive surgical procedure in which the damaged or diseased kidney is replaced with a healthy kidney received from a living or deceased donor. Kidney transplant is often the last resort to kidney failure. It majorly depends upon the availability of the donor kidney.

What are the complications of diabetic kidney disease?

If diabetic nephropathy is left untreated or unmanaged, it can lead to several different types of complications over months or years, such as:

• Fluid retention leading to swelling in arms and legs
• Fluid in your lungs (pulmonary edema) due to retention 
• High levels of potassium levels in the blood 
• Cardiovascular diseases and stroke
• Damage to the blood vessels of the retina 
• Anaemia
• Foot sores 
• Erectile dysfunction
• Damaged nerves and blood vessels 
• Pregnancy & birthing complications 
• End-stage kidney disease

How long does it take for diabetes to cause kidney damage?

You can expect to see some form of minor changes in the kidney function after 2-5 years of diabetes diagnosis if you have uncontrolled blood sugar and hypertension. A more serious form of kidney damage is usually seen in diabetic patients within 10 years. 

Can kidney disease cause diabetes?

It is evident that diabetes can cause kidney disease, however, there is little information on the reverse, that is, whether or not kidney disease can cause diabetes. 

Studies have shown that kidney diseases can increase the risk of diabetes. When kidneys lose their ability to function, the waste products keeps building up in your blood. One such waste, known as urea, also increases as a result of kidney damage. Increase in the levels of urea has been linked with an increased probability of diabetes. 

What are the ideal diabetes and kidney disease diet?

The dietary management of diabetic nephropathy can be an effective way to control kidney damage and improve your health. Here are some recommendations on foods to eat and foods to avoid with kidney disease and diabetes.

Foods and beverages to have:

Legumes (beans), peas, squash, pumpkin, sweet potatoes, corn, oatmeal, quinoa, barley, non-starchy vegetables, water, herbal tea, almond milk or soy milk, greek yogurt, popcorn, whole-grain crackers, whole grain cereals. 

Foods and beverages to avoid:

Fruit juice, soda, sweetened iced tea and coffee drinks, white bread, multi-grain bread, white pasta or rice, muffins, croissants, sugary cereals, chips, pretzels, sweetened dried fruit, cookies, cake, ice cream, candy, syrup. 

How to reverse kidney damage from diabetes?

Mild kidney damage from diabetes is reversible with the help of an actively monitored lifestyle and medical management. 

Here’s what you can do to reverse diabetic nephropathy:

• Keep your blood sugar controlled
• Control your high blood pressure 
• Eat a healthy diet with moderate amounts of sodium & potassium
• Exercise regularly 
• Visit your medical expert regularly 

The concluding note 

Diabetic Kidney Disease affects nearly 1/3rd people living with diabetes. However, an active life, healthy diet and routine checkup with your medical expert can help in reducing your risk of this ailment. 

For more personalised guidance on diabetes and kidney disease, book an appointment with Dr Mohit Khirbat, a top nephrologist at the CK Birla Hospital. 

FAQs

Ques: What are the signs of stage 1 kidney disease?

Ans: The presence of protein in the urine and/or physical damage to the kidney are common signs of stage 1 kidney disease. 

How long does it take for diabetes to cause kidney damage?

Ans: It takes about 2-5 years for mild diabteic kidney disease to develop. 

Ques: Can you reverse kidney damage caused by diabetes?

Ans: Yes, you can reverse mild kidney damage from diabetes with lifestyle moderations and clinical management. 

Ques: Is diabetic nephropathy curable?

Ans: No, there is no cure for diabetic nephropathy but you can slow down the progression of the disease, significantly.