Diabetes and your kidneys

Nephropathy is the gradual loss of kidney function. When this condition becomes severe, it is called " kidney disease " or " kidney failure ."

People with diabetes are at increased risk of developing this nephropathy condition. It is reported that a significant number of adults with diabetes may experience early symptoms of kidney disease.

This condition can worsen high blood pressure and heart disease (which are also common with diabetes). If left untreated, kidney disease can lead to kidney failure, which can be life-threatening.

Therefore, it is very important for everyone with diabetes to be aware of the health of their kidneys, monitor them, and protect them.

What is diabetic kidney disease?

This is a kidney disease that is often caused by high blood sugar (glucose) levels over a long period of time. People with type 1 and type 2 diabetes are at a significant risk of developing this kidney disease.

The kidneys filter waste products from our blood and remove them through urine. They also help regulate the amount of salt and minerals in the body. They also produce hormones that control blood pressure , make red blood cells, and help keep bones strong.

When blood sugar levels are high over time, the small blood vessels in the kidneys are damaged, reducing the kidneys' ability to function. When this damage becomes severe, it is diagnosed as kidney disease.

If this is not treated, the kidneys can become completely dysfunctional. The kidneys can then no longer filter waste products. When this happens, the kidneys will have to do the work they used to do in a different way - either by having regular dialysis treatments (cleaning the blood with a machine), or by having a kidney transplant .

How can you reduce the risk of kidney disease?

If this kidney disease is detected in its early stages, its progression can be controlled, stopped, and sometimes even reversed .

For this to be successful, it is important to recognize the disease quickly and take a very diligent look at your health.

You can do these things to maintain kidney health:

• Keeping blood sugar levels within the range prescribed by doctors.
• Controlling blood pressure and keeping it at the right level.
• Some over-the-counter painkillers and anti-inflammatory medications (those taken without a doctor's prescription) can be harmful to the kidneys, so be very careful when using them (ask your doctor about this).
• Eating a diet low in protein, sodium (salt), and potassium .
• Controlling cholesterol levels .
• Exercising regularly.
• Completely abstain from smoking .
• Limiting alcohol consumption .
• Managing stress effectively (e.g., meditation, relaxation).

The best way to protect your kidneys is to control your blood sugar and blood pressure. Keeping both of these at the right level can go a long way in preventing kidney disease.

Although some medications cannot cure kidney disease, they can help control the health and function of the kidneys. (For example, medications that control blood pressure, medications that lower blood sugar levels and are also good for the kidneys, medications that remove excess fluid from the body, and medications that control cholesterol.) Ask your doctor about these.

What tests are used to diagnose kidney disease?

There are no obvious symptoms of this kidney disease in the early stages. Later, symptoms such as:

• Swelling (fluid accumulation)
• Feeling like an upset stomach
• Appetite

However, since these signs are not specific to the kidneys, they may not be taken into account.

Urine tests and blood tests are performed to check the health of the kidneys and to determine if kidney disease has developed due to diabetes.

Urine test (for albumin/protein):

A urine sample is taken and checked for protein (specifically a type of protein called albumin) . Normally, protein is not found in urine. If it is, it means that there is some damage to the kidneys ( albuminuria ). If the level of protein in the urine is only slightly elevated, but if it persists ( microalbuminuria ), it can also be an early sign of kidney disease and an indication of heart disease.

Blood test (for eGFR):

A blood sample is taken to measure a waste product called creatinine , which is produced by the body's tissues. The creatinine level is then used to calculate a value called eGFR (estimated glomerular filtration rate) , based on factors such as age and body size. This eGFR value tells us how well the kidneys are working. It can also tell us what stage of kidney disease, if any, it is in.

Why is regular kidney check-ups important for diabetics?

It is important for everyone with diabetes, especially those who have had diabetes for several years, to have their kidneys checked at least once a year (or as directed by their doctor) . If someone is diagnosed with kidney disease, their doctor may recommend more frequent tests to monitor the progress of the disease and decide on treatment.

How is kidney disease treated? (Stages of the disease)

Kidney disease caused by diabetes is divided into five main stages . These stages are determined by the eGFR value mentioned earlier. The higher the eGFR value, the better.

• Stages 1 and 2: Early stages. Usually no major symptoms. eGFR is relatively high.
• Stage 3: Kidney function has decreased to a moderate level. Symptoms such as swelling may appear. The eGFR value is even lower.
• Stage 4: Kidney function has significantly decreased. Symptoms become more apparent. The eGFR value is even lower.
• Stage 5: This is complete kidney failure . The eGFR is very low. At this point, dialysis (blood purification) or a kidney transplant is absolutely necessary to survive.

From stages 1 to 4, the disease can be controlled by making lifestyle changes, managing the disease well, and sometimes using medication. But when you reach stage 5, your kidneys are no longer working, so you will definitely need dialysis or a kidney transplant.

Dialysis: This involves being connected to a machine several days a week, for a few hours at a time, to clean your blood. This is a continuous, time-consuming and labor-intensive treatment.

Kidney transplant: This is a major surgery. You need to take great care before and after the surgery. Finding a kidney from a suitable donor can be difficult. It also requires a significant amount of money and healthcare resources.

Things to remember

Kidney disease is one of the most serious complications of diabetes. However, not everyone with diabetes develops kidney disease .

By practicing good health habits, getting regular checkups, and taking the necessary medications as directed by your doctor, you can go a long way toward maintaining good kidney health and preventing the need for dialysis or a kidney transplant.