Does diabetes also affect the kidneys? Let's be aware of Diabetic Kidney Disease!

Do you have diabetes? Or does someone in your family or friend have diabetes? Then you probably know about the various complications that come with diabetes. Sometimes we can be afraid because we are not fully aware of these. Today we are going to talk about the effects that diabetes can have on our kidneys. This is called Diabetic Kidney Disease (DKD).

What is Diabetic Kidney Disease (Diabetic Kidney Disease)?

Simply put, this is damage to your kidneys due to diabetes. We know that the two kidneys in our body filter the blood and remove waste products . Think of the kidneys as two super filters in our body. These filter nitrogenous waste products, for example urea, waste products from the muscles (creatinine), and many other toxins and excrete them with urine. Not only that, the kidneys also help maintain the balance of fluid and electrolytes in the body.

Each kidney contains more than a million tiny filtering units called nephrons. Inside these nephrons, tiny blood vessels are connected to form a mesh-like structure called a glomeruli. In fact, these glomeruli are the first step in blood filtration. They allow water and dissolved waste products to pass through their semi-permeable membranes, which are then excreted from the body as urine.

Now look, what happens to the body of a person with diabetes? Their body cannot properly use the sugar that we get from the food we eat, that is, `(glucose)`. Then the `(glucose)` level in the blood increases. When this high amount of `(glucose)` is present for a long time, the delicate membranes of those `(glomeruli)` start to get damaged. And other parts of the `(nephron)` can also get damaged. The `(glomeruli)` that are damaged in this way cannot filter the blood properly. Then, what happens is that the toxins that should be excreted with the urine start to accumulate inside the body.

Is this situation serious?

Yes, kidney disease caused by diabetes is a serious condition . If it is not managed properly, it can eventually lead to kidney failure . Kidney failure can be life-threatening. Therefore, it is very important to be aware of this.

What are the stages of kidney disease due to diabetes?

The eGFR is a measure of how well your kidneys are working. The eGFR is an abbreviation for estimated glomerular filtration rate. Simply put, it's a calculation of how efficiently your kidneys filter waste products. A healthy person's eGFR is around 100. This value can drop to 0, which means your kidneys are not working at all.

There are several stages of any kidney disease, including kidney disease caused by diabetes:

• Stage I:Your GFR is 90 or higher. At this point, your kidneys may have suffered some damage, but they are still functioning normally.
• Stage II: The GFR value can be between 60 and 89. The kidneys are more damaged than in stage I, but still function well.
• Stage III: The GFR value may be between 30 and 59. At this point, kidney function may be mildly or severely reduced.
• Stage IV: The GFR value can be between 15 and 29. This means that kidney function has severely decreased.
• Stage V: The GFR is less than 15. This means that the kidneys are close to complete failure, or have failed.

Who is most likely to develop this disease? What are the risk factors?

Anyone with type 1 or type 2 diabetes can develop kidney disease. However, some people are at higher risk. For example:

• Black people
• American Indian, Alaskan Native, or First Nations people
• Polynesian people
• Maori people

There are other risk factors:

• Having kidney disease in the family.
• Having high blood pressure.
• Use of tobacco products (such as cigarettes).
• Hyperglycemia is a condition where blood sugar levels are consistently high.
• High blood cholesterol levels (Hyperlipidemia).

How common is this disease?

Kidney disease caused by diabetes is a very common condition . It is the leading cause of end-stage renal disease worldwide. It is estimated that approximately 40% of people with diabetes develop this kidney disease.

What are the symptoms of kidney disease caused by diabetes?

In most cases, obvious symptoms do not appear until 80% to 90% of the kidneys have been damaged. When symptoms do appear, you may notice things like:

• Swelling of the face, hands, and legs (edema).
• Nausea and vomiting.
• Constant feeling of tiredness or fatigue.
• Difficulty breathing (dyspnea).
• The food is tasteless.
• Foamy or bubbly urine.
• Difficulty concentrating or feeling confused.
• Dry and itchy skin.
• Muscle cramps.
• Needing to reduce the amount of insulin taken (for those taking medication for diabetes).

What are the symptoms in the early stages?

Kidney disease due to diabetes often does not show any symptoms in the early stages.. You may have protein in your urine (proteinuria). But this can only be detected by a doctor who performs a urinalysis.

What causes this? Is it contagious?

The main reason for this is having type 1 or type 2 diabetes.

No, this is not a contagious disease. You cannot spread this disease to anyone else.

How do you find out if you have kidney disease due to diabetes?

If you have diabetes, it's important to see your doctor every three to six months for a check-up, as recommended by your doctor. If your doctor suspects that you may have diabetes-related kidney disease, he or she will order some tests.

What tests are done to detect this?

The following tests help diagnose this disease:

• Urinalysis:

This involves taking a sample of your urine and examining it for its appearance, chemical composition, and microscopic examination. Your doctor may use a dipstick to do this test. He or she may also recommend different types of urine tests. In a dipstick test, you urinate into a special container. Then a paper strip (dipstick) that has chemicals applied to it is placed on it. If there is protein (albumin) in the urine, the strip will change color.

If your doctor needs a more accurate measurement, they may order a urine protein test . This involves sending a sample of your urine to a lab to look at the ratio of protein to creatinine in your urine (protein-to-creatinine ratio). If this ratio is too high, it could be a sign of diabetes-related kidney disease.

• Blood tests:

The eGFR test measures the ability of your kidneys to filter blood. Your doctor will take a small amount of blood from a vein in your arm and use the creatinine level in the blood and some basic health information to calculate your eGFR.

• Imaging tests:

These tests can help your doctor get an idea of ​​the health of your kidneys.

• Ultrasound tests: These can check the structure and size of the kidneys.
• MRI and CT scans: These can clearly see the blood vessels and blood supply to the kidneys.

• Kidney biopsy:

In this procedure, the doctor takes a small piece of tissue from your kidney and examines it under a microscope in a laboratory. Before doing this, the area is numbed so you don't feel any pain. He or she will also give you a light sedative to help you relax. Then, a needle is inserted through the skin into the kidney and the tissue sample is taken.

What are the treatments for this?

Treatment depends on the stage of your disease, your age, and your overall health. Controlling your diabetes is the first step in treating this kidney disease. The following things can help you manage your diabetes:

• Include more foods that are high in fiber, low in fat and calories in your diet.
• Exercising regularly.
• Controlling body weight.
• Stop smoking or using other tobacco products.

If you have high blood pressure, it is important to treat it as well. Your doctor may prescribe medication for high blood pressure.

Can kidney damage be reversed?

No, kidney damage caused by diabetes cannot be completely reversed. However, you can control, slow down, and possibly even stop further kidney damage by taking your medications as prescribed by your doctor, following a healthy diet, and staying physically active.

What medications are given for this?

To manage diabetic kidney disease, it is important to control your diabetes, lower your blood pressure, and lower your cholesterol levels. Your doctor may prescribe the following medications to treat these conditions:

• For diabetes:
• Biguanides (e.g. metformin): These reduce the amount of glucose your liver makes. They also improve the way insulin works in the body, slowing down the rate at which carbohydrates are converted into sugar.
• Sodium-glucose cotransporter 2 (SGLT2) inhibitors: These help the kidneys remove glucose from the body through the kidneys and urine.
• Glucagon-like peptide 1 (GLP-1) agonists: These increase insulin release, reduce glucose release from the liver after a meal, and delay gastric emptying. This may also help with weight loss.

• For high blood pressure:
• Angiotensin-converting enzyme (ACE) inhibitors: These block the production of a hormone called angiotensin II. The body naturally uses this hormone to control blood pressure. After treatment with ACE inhibitors, blood pressure should decrease.
• Angiotensin II receptor blockers (ARBs): These stop the hormone angiotensin II from binding to receptors on the blood vessels. ARBs work in a similar way to ACE inhibitors, lowering blood pressure.

Important: In addition to lowering blood pressure, ACE inhibitors and ARBs also help slow the progression of diabetes-related kidney disease.

• For high cholesterol:
• Statins: These lower bad cholesterol and raise good cholesterol. They may be helpful for some people with diabetes-related kidney disease.

What is the treatment if the disease worsens?

If diabetic kidney disease becomes severe, treatment options include:

• Dialysis: If your kidneys are not working properly, dialysis can do the job for your kidneys. In this, a machine takes your blood, filters out waste products and extra fluid, and returns the cleaned blood to your body.
• Kidney transplant: In this, you receive a healthy kidney from someone else (a kidney donor).

How can you avoid this disease?

The best way to prevent diabetic kidney disease is to manage your diabetes and blood pressure well. It's important to follow the treatment plan your doctor prescribes exactly.

What can someone with this disease expect?

Diabetic kidney disease is a slowly progressive condition . If you have this disease, the damage to your kidneys cannot be reversed. However, if you catch the disease early and follow a proper treatment plan, you can slow down or even stop the progression of the disease.

If this disease becomes severe, it can lead to kidney failure, which is life-threatening. The treatment options for kidney failure are dialysis or a kidney transplant.

How should I take care of myself?

Your doctor will help you develop a treatment plan that's right for you. It may include medications and lifestyle changes. Your treatment plan may include:

• Taking the diabetes and blood pressure medications prescribed by the doctor exactly.
• Check your blood sugar levels and blood pressure regularly.
• Following a healthy diet (such as the Mediterranean diet or the DASH diet).
• Exercise for at least 30 minutes a day most days of the week. Try to get at least 150 minutes of exercise a week. You can walk, run, bike, swim, or do any other cardiovascular activity you like.
• Avoiding medications that can damage the kidneys. This may include some painkillers (non-steroidal anti-inflammatory medicines - NSAIDs).
• Keeping doctor appointments and getting all lab tests done.
• Stop smoking or using other tobacco products.
• Limiting the amount of alcohol you drink.
• Get between seven and nine hours of sleep every night.

When should I see a doctor?

If you have diabetes, you should see your doctor regularly every three to six months, as recommended by your doctor.

If you have diabetes, your doctor will recommend annual screening for diabetic kidney disease , starting five years after your diagnosis. Kidney damage usually doesn't become apparent within the first 10 years after you're diagnosed with diabetes. If you've had diabetes for more than 25 years and your kidneys haven't been damaged, you're less likely to develop diabetic kidney disease.

What questions should I ask the doctor?

It's very important to ask questions like these when you see your doctor:

• How do you know if I have kidney disease due to diabetes?
• Should I see a nephrologist or another specialist?
• What tests do you perform to diagnose diabetes-related kidney disease?
• How severe is my diabetic kidney disease?
• What lifestyle changes can I make to slow or stop the progression of my diabetes-related kidney disease?
• What medications do you recommend?
• What treatments do you recommend?
• How often do I need to come for appointments?
• Can you recommend support groups for people with diabetes-related kidney disease?

This is the most important message I have to give you...

Kidney damage from diabetes is a serious condition. It can progress to kidney failure, which is life-threatening. If your doctor diagnoses you with diabetes-related kidney disease, it's normal to feel scared and sad. However, if you catch the disease early and follow your treatment plan carefully, you can slow down or even stop the progression of diabetes-related kidney disease.

Getting treatment for a condition like this can be emotionally stressful. But remember, your doctor is there to help you. He/she is committed to answering all your questions and helping you maintain your quality of life. So don't be afraid to talk to your doctor about everything that's on your mind.

` Diabetes, Kidney Disease, Diabetic Kidney Disease, DKD, Nephropathy, eGFR, Urine Test, Dialysis