Berhampur;The prevalence of Diabetes is increasing across the globe and in India. Currently India houses approximately 7.5 crore diabetics. Compared to western countries, Indians get affected by Diabetes a decade earlier. That leads to higher occurrence of other complications like heart and kidney disorders. Diabetes is one among the main causes of kidney problems. The small vessels in kidney get affected. Therefore it cannot clean the blood and waste materials get deposited in excess amount. Water and salt get accumulated in body giving rise to weight gain and ankle swelling at the early stages. Additionally the small urinary tubules too get damaged leading to leakage of protein and increased urinary excretion of protein. This further adds upto swelling of body. Presence of comorbid conditions like hypertension, obesity and cholesterol problems further plays a damaging role in kidney.
One of the earliest manifestations of kidney disorders include increased urinary excretion of albumin. Therefore annually once urine albumin test is mandated in diabetic patients. There is increased urination at night along with increase in blood pressure. Further damage to kidney leads to elevation of Blood Urea Nitrogen (BUN) and creatinine in blood. The symptoms include nausea, vomiting, headache, loss of appetite, weakness, lethargy, muscle cramps, poor sleep and concentration, frequent episodes of hypoglycaemia (low blood sugar) and reduction in requirement of antidiabetic drugs. In end stage kidney disease, itchinee, dry skin and drowsiness are seen. In case of appearance of any of the symptoms, prompt consultation with doctor is advised.
Prevention is better than cure. Therefore all the diabetic patients should test their blood and urine at least once every year. The early markers for kidney dysfunction include Glomerular Filtration Rate (GFR) and Urine for Micral. After diagnosis of kidney ailment, some more tests are done to rule out other causes of kidney disorders. Kidney biopsy is one such test where a tag of kidney tissue is taken out by a fine needle and studied under microscope. Ultrasound of abdomen along with DTPA and DMSA scans are done sometimes to know the structural and functional abnormality of kidneys.
In order to let the kidney work efficiently over a long term in Diabetic patients, some steps are required
Weight reduction followed by achievement of normal weight and its maintenance by diet restriction and regular exercise.
Proper control of blood sugar with maintenance of fasting blood sugar below 120 mg/dl, post prandial blood sugar less than 160 mg/dl and HbA1C (Marker of 3 months blood sugar) below 7%. Certain antidiabetic drugs which have a propensity of causing hypoglycaemia (low blood sugar) are better avoided. Newer antidiabetic drugs like Gliptins and Gliflozins offer kidney protective effects in addition to lowering blood glucose without any hypoglycaemia. In advanced kidney disease cases, Insulin is the only savior for the diabetic patients.
Adequate control of blood pressure (less than 130/80 mm Hg). ACE Inhibitors and ARBs are preferred class of drugs to reduce BP for their beneficial effects.
Control of blood cholesterol with Statin class of drugs;
Prompt treatment of any urinary tract infection.
Timely correction of any structural abnormality or extraction of stone in urinary tract.
Avoidance of usage of medicines harmful for kidney like pain killers, unsupervised usage of antibiotics)
Restricted use of protein, especially of non vegetarian origin.
Adequate fluid intake with avoidance of alcohol and smoking.
In end stage kidney disease, generally frequent dialysis is done to clean the blood. Ultimately kidney transplantation is the option for many patients. Everyone should be aware of the fact that, there is no cure of kidney problems. But proper treatment of underlying condition with normal blood sugar, pressure and cholesterol would certainly halt the progress to more advanced stages of kidney disease.
Dr Sunil Kumar Kota
MD (Medicine), DNB (Endocrinology)
Consultant Endocrinologist, Diabetes & Endocare Clinic,