Doctor explains Diabetic Kidney Disease | Causes, symptoms, treatment and prevention

Diabetic kidney disease, also known as diabetic nephropathy, is a significant complication that can arise in individuals with diabetes. Understanding this condition is crucial for anyone managing diabetes, as it can lead to severe health issues, including kidney failure. In this article, I will delve into the essential aspects of diabetic kidney disease, including its causes, symptoms, diagnosis, risk factors, treatment options, and outlook.

What is Diabetic Kidney Disease?

Diabetic kidney disease occurs when high blood sugar levels damage the kidney's filtering units, known as glomeruli. This damage leads to the leakage of a protein called albumin into the urine, a condition referred to as albuminuria. Initially, this leakage may be mild, but it can worsen over time, resulting in decreased kidney function. If left untreated, diabetic kidney disease can progress to end-stage renal failure, necessitating dialysis or a kidney transplant.

Prevalence and Risk Factors

Diabetic kidney disease is the leading cause of kidney failure in the UK, affecting approximately 30-40% of individuals with diabetes. The risk of developing kidney issues varies between type 1 and type 2 diabetes. In type 1 diabetes, early signs may appear five years post-diagnosis, with a significant increase in risk after 30 years. Conversely, many individuals with type 2 diabetes may already exhibit kidney changes at the time of diagnosis due to prolonged high blood sugar levels.

Certain populations, particularly South Asian and Black individuals, are at a higher risk for developing diabetic kidney disease. Factors contributing to this increased risk include prolonged high blood sugar levels, high blood pressure, obesity, smoking, and a family history of kidney disease.

Symptoms of Diabetic Kidney Disease

In the early stages, diabetic kidney disease may not present any noticeable symptoms, which is why regular check-ups are vital. As the condition progresses, individuals may experience:

• Fatigue
• Loss of appetite
• Swelling in the feet and ankles
• Puffiness around the eyes
• Increased frequency of urination

In more advanced stages, complications such as anemia and bone health issues may arise due to the kidneys' inability to regulate essential minerals.

Diagnosis

Diagnosing diabetic kidney disease typically involves two key tests conducted annually for individuals with diabetes:

1. Urine Test: This test measures the amount of albumin in the urine, specifically looking at the albumin-to-creatinine ratio (ACR). An ACR between 3 and 30 mg/mmol indicates microalbuminuria, while levels above 30 mg/mmol signify more advanced proteinuria.
2. Blood Test: This test assesses kidney function by measuring creatinine levels to estimate the glomerular filtration rate (eGFR). An eGFR above 60 is generally considered normal, while values between 15 and 59 indicate reduced kidney function, and below 15 suggests kidney failure.

In some cases, additional imaging tests or a kidney biopsy may be necessary to clarify the diagnosis.

Treatment Options

Managing diabetic kidney disease involves a multifaceted approach:

• Medications: ACE inhibitors and Angiotensin II receptor antagonists help lower blood pressure and protect kidney function. SGLT2 inhibitors assist in eliminating excess sugar through urine, reducing kidney pressure. Newer medications like Feron target hormones that can damage the kidneys.
• Blood Sugar Control: Maintaining a healthy HbA1c level is crucial in slowing kidney damage.
• Blood Pressure Management: Keeping blood pressure within a healthy range is essential, often requiring multiple medications.
• Lifestyle Changes: Adopting a healthy lifestyle is paramount. This includes quitting smoking, maintaining a balanced diet, managing weight, and staying physically active.
• Cholesterol Control: Statins may be prescribed to manage cholesterol levels and reduce the risk of heart disease.

Outlook

The prognosis for diabetic kidney disease varies among individuals. If detected early, treatments can often reverse early signs of kidney damage. Even in advanced stages, appropriate management can slow disease progression. However, individuals with diabetic kidney disease face an increased risk of cardiovascular events, making it essential to address other risk factors such as high cholesterol and hypertension.

In conclusion, while diabetic kidney disease poses significant risks, proactive management and regular monitoring can help individuals with diabetes maintain their kidney health and overall well-being. Collaborating closely with healthcare providers and making informed lifestyle choices are key to minimizing risks and enhancing quality of life. If you have any questions or need further clarification, please feel free to reach out in the comments section.

Please note this is a general educational resource only - and not individual clinical advice. For all individual clinical questions always speak to your own healthcare provider.