What Happens to the Kidneys in Diabetes?

Diabetes is a condition that can progressively affect many different organs in your body. If you have diabetes, you should be aware that your kidneys may get impacted by a progressive condition known as diabetes-associated nephropathy (DAN). Keeping your blood sugar and blood pressure levels in check can help prevent this condition!

Understanding Diabetes and Diabetes-Associated Nephropathy

The way your body transforms food into energy is influenced by diabetes. When you have diabetes, your body either produces insufficient insulin (type 1 diabetes) or uses it improperly (type 2 diabetes). Excessive blood sugar remains in your circulation in such conditions. This can eventually lead to major health issues such as kidney disease, eyesight loss, and heart disease.1

Approximately 20-30% of individuals with diabetes experience diabetes-associated kidney disease known as nephropathy.2 The prefix ‘nephro’ is derived from the Greek word nephros, which denotes kidney.

Your kidneys are responsible for filtering the used blood that returns to them. Basically, they clean your blood and remove waste products through urine. The fluid and electrolyte balance in your body is also maintained by your kidneys. More than a million nephrons (filtering units of a kidney) may be found in each kidney.

Nephrons assist in filtering your blood and maintaining the electrolyte balance. A glomerulus, or a collection of small blood vessels, is found within each nephron, through which water and soluble wastes are removed from the urine. In the case of DAN, the glomeruli may get damaged as a result of elevated blood sugar levels and become ineffective in filtering fluids effectively. Kidney failure may result from nephropathy brought on by diabetes.

What Causes Diabetes-Associated Nephropathy?

Among individuals with long-term diabetes, the presence of high blood sugar levels and hypertension (high blood pressure) are the common risk factors associated with the development of DAN.

Other causes of DAN include:

• A family history of kidney disorders
• A sedentary lifestyle
• Higher consumption of salty foods
• Use of tobacco products
• Excess weight
• High cholesterol levels
• Uncontrolled blood pressure
• Heart disease

Stages of Diabetes-Associated Nephropathy

In order to produce urine, your kidneys filter your blood by eliminating waste and surplus water. The kidneys' ability to filter is indicated by their glomerular filtration rate (GFR). The normal value of estimated GFR (eGFR) is typically 100. When the eGFR falls to zero, kidney function is completely lost.

DAN can progress over five stages that may continue over several years. Your eGFR can indicate the stage of DAN you are now experiencing.

Symptoms of Diabetes-Associated Nephropathy

A majority of the time, symptoms of DAN don't manifest until at least 80–90% of your kidneys have been impacted. The symptoms that may occur include:

• Swelling in the hands, feet, and face due to fluid retention
• Generalised weakness and constant tiredness
• Breathlessness
• Headache
• Bubbled or foamy urine
• Trouble focusing on routine tasks
• Dry itchy skin
• Reduced appetite
• Nausea and vomiting
• Gastric discomfort
• Sleeplessness
• Muscular pain
• A reduction in the dose of insulin needed

How do I Know Whether I have Diabetes-Associated Nephropathy?

Several tests are used to identify DAN, including:

1. Laboratory investigations

• Urine tests to check the protein level
• Blood tests to determine the kidney function
• Kidney tissue biopsy to check if another disease is the cause instead of diabetes

2. Imaging tests

• Kidney ultrasonography to help visualise the size and structure of the kidneys
• Magnetic resonance imaging (MRI) and computed tomography (CT) to examine the arteries leading to the kidneys for narrowing, which can lead to a decline in kidney function

3. Self-check-measures

• Regular blood pressure measurement

How Can Diabetes-Associated Nephropathy Be Treated?

DAN can only be managed and not cured completely.

1. Prevention

The best treatment for DAN is prevention, which involves maintaining stable blood pressure and blood sugar levels. Elevated blood glucose levels are one of the prime causes of kidney failure.

2. Self-help

The following measures can be taken to manage DAN:

• Adding high fibre, low calorie and protein content to your meals
• Exercising regularly
• Ensuring a healthy weight range for your age and height
• Giving up on smoking and other tobacco use

3. Doctor’s intervention

• Medications may be prescribed by your doctor for high blood sugar, blood pressure and cholesterol to prevent kidney damage due to these conditions.
• Dialysis can be performed to help eliminate waste while preserving water and salts. Multiple dialysis sessions, multiple times a week may be needed.
• A kidney transplant can be done to replace the damaged kidney with a healthy kidney taken from a live donor or a deceased donor.

Conclusion

As the kidney function gradually declines towards kidney failure, treatment must become progressively more vigorous because there is no cure. Therefore, early intervention is required to prevent kidney disease or delay the progression of the disease. If you have diabetes, you must visit your healthcare provider every three to six months or as advised by your doctor.

Your doctor will advise yearly testing for DAN five years after being diagnosed with diabetes. Within the first 10 years of your diabetes, kidney damage typically does not manifest. You are less prone to develop DAN if you have had diabetes for more than 25 years and haven’t had kidney damage.

Households with diabetes have a severe financial burden due to hospitalisation expenses. Hence, it’s always recommended to intervene at the early stages to keep the complications at bay and live a healthy life.