Diabetes and Your Kidneys

The kidney filters and removes metabolic waste (the waste products from the reactions in the body), excess water and salt in the blood through urine. It also helps control the blood pressure and produces hormones the body needs to keep healthy. If there is a problem with the kidney, toxic metabolic waste will accumulate and cause various health problems.

Diabetic nephropathy is a kidney disease that arises due to poorly managed diabetes. Nearly one in four diabetics will develop this condition.

What causes diabetic nephropathy?

Uncontrolled high blood glucose levels in diabetics can damage the blood vessels of the kidney. The kidney is also more likely to be damaged if the person also has high blood pressure (hypertension).

There are several risk factors which increase the occurrence of diabetic nephropathy:

• Overweight or obese
• Having heart disease
• Family history of kidney failure
• Physical Inactivity or sedentary lifestyle
• Not having a healthy diet
• Eating too much of salty food
• Being a Smoker
• Having vision problems due to diabetes (diabetic retinopathy) or nerve disorders (diabetic neuropathy).
• Afro-American, American-Indian, or Hispanic races

What are the symptoms?

In general, diabetic nephropathy does not cause any symptoms until the kidney functions have decreased drastically. Most people who have diabetic nephropathy may still produce a normal amount of urine.

Below are signs and symptoms of diabetic nephropathy in an advanced state:

• Blood pressure that is difficult to control even with drugs
• Presence of protein in the urine
• Swelling of the feet, ankles, hands or eyes
• Increased desire to urinate
• Confused, difficult to focus or concentrate
• Loss of appetite
• Nausea and vomiting
• Itchiness of skin
• Fatigue

The normal kidney can filter out proteins so they don’t leak into the urine. Therefore, measurement of protein levels in the urine is one of the important tests to detect diabetic nephropathy. Blood tests can also be done to assess kidney function.

How is it treated or managed?

Managing diabetes. is the main way to go about this. By controlling both blood sugar levels and blood pressure, the progressive decline in kidney function can be slowed down.

If diabetic nephropathy is still in its early stages, treatment is aimed to:

• Achieve blood sugar control targets, haemoglobin A1C (HbA1C) levels are lower than seven per cent. Control the blood pressure to be below 140/90 mmHg. Usually assisted with drugs such angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARB) groups (remember these medications should only be taken as prescribed by a doctor). The active substances in these medicines have the suffix -pril or -sartan.
• Control the protein levels in the urine. Some drugs can reduce the levels of albumin protein in the urine and improve the kidney function.
• Reduce the elevated cholesterol levels. Usually, this is achieved by using anticholesterol drugs from statins. This type of drug can also help reduce protein levels in the urine.
• Maintain bone health through drugs that affect calcium phosphate balance.

The right medicines combined with good eating habits help immensely. In general, there are five things that need to be focused on the diet for diabetic nephropathy:

• What is healthy for the heart is also healthy for the kidneys. Prioritize food that is baked, steamed, boiled, or sauteed rather than fried. Choose lean meat without visible fat, use healthy oils like olive oil or canola oil, and limit consumption of saturated fatty acids and trans fatty acids.
• Choose foods and drinks with low phosphorus levels. Excess phosphorus in the blood will draw calcium from the bone so that the bone becomes weak and vulnerable to fracture. In addition, excess phosphorus can also trigger itching on the skin, as well as bone and joint pain. Low-phosphorus foods can be obtained from fruits and vegetables, bread, pasta, rice, corn, cereals, and tea.
• Pay attention to the daily consumption of potassium. Kidney damage causes potassium to accumulate in the blood, which can lead to serious heart problems. Example of low potassium foods include apples, grapes, peaches, carrots, beans, white bread and pasta, white rice, and whole-grain cereals.
• Consumption of foods low in salt. The limit is less than 2,400 mg of sodium salt per day or three-quarters of a teaspoon.
• Consumption of right type and amount of protein. When protein consumption is excessive, the kidney will be increasingly burdened. For this reason, patients with diabetic nephropathy are encouraged to consume protein in small portions.

Animal protein sources:

• 1 serving = 2-3 ounces, or 1 palm.
• 1 serving of dairy products = ½ cup of plain milk/yoghurt; or 1 sheet of cheese

Vegetable protein sources:

• 1 serving of legumes = ½ cup
• 1 serving of beans = ¼ cup
• 1 serving of cereals = 1 sheet of bread; ½ cup of rice/noodles

Some treatment options that can be done when diabetic neuropathy has entered an advanced stage that will eventually lead to kidney failure.

• Kidney dialysis. This method can eliminate metabolic waste and excess fluid from the blood. There are two types of dialysis which are hemodialysis and peritoneal dialysis. Hemodialysis is generally done 2-3 times a week and must be done in a hospital. While peritoneal dialysis can be done at home.
• Transplantation. If the kidney function has greatly declined and dialysis is no longer effective, kidney transplantation is the best solution. However, patients must be eligible to undergo this procedure.

The requirements for a kidney transplant are:

• Having the same blood type as the donor
• Not having an autoimmune disease
• Not experiencing an infection
• Not cancer survivors
• Having a healthy heart condition

If these methods are not undertaken, the life expectancy for those with an advanced stage of diabetic nephropathy is generally only a few months. Therefore, doctors will only provide treatments that make it comfortable to deal with symptoms.

Prevention

• Control diabetes to achieve targeted blood sugar levels.
• Control high blood pressure and other medical conditions.
• Not using any over-the-counter medicines such as pain relievers from aspirin, ibuprofen or paracetamol. In people with diabetic nephropathy, improper use of these drugs can make the kidney function worse.
• Implement a healthy lifestyle by stopping smoking, having a good diet, exercising regularly, maintaining a normal weight range and getting enough sleep (7-8 hours a day).

Your nephrologist will guide you through the goals and treatment plan for managing your condition. Your dietician will assist you to make dietary changes that will help reduce the load on your already overworked kidneys.