Tamil Nadu

Protect your kidneys from diabetes

It is a startling statistic that the number of people with diabetes is presently about 150 million. In India contributes 20 million patients which are expected to reach 57 million by the year 2025 so that every 4th diabetic in the world will be an Indian. The incidence is rising alarmingly in urban population.

Every one out of four diabetic patient is at risk of developing Kidney disease. There are many explanations as to why we Indians are more prone to develop Diabetic Kidney disease. Maternal malnutrition during child bearing years puts the unborn child at risk of development of so called adult diseases such as hypertension and Diabetic Kidney disease. Growth retardation in side the uterus leads on to developmental defects in the Kidneys such that they are endowed with lesser number of functional units called Nephrons.This puts them at a greater risk of development of Kidney disease in later life. Family history of diabetic kidney disease puts the patient at a higher risk category since genetic factors are at work. If the family members have high blood pressure then the risk of development of kidney disease more than doubles.

It takes on an average 10 years to develop kidney disease. That gives every patient a window of opportunity to prevent kidney disease. During the early stages of kidney disease there are no symptoms. Leg swelling may be noticed on prolonged travel or standing. In later stages of kidney disease the appetite becomes less and the patient vomits .In more advanced stage of the disease when 90 % of the kidneys are damaged life threatening heart failure and uremic coma may develop. Let us look at the ways to protect the kidneys in diabetes. Firstly, Blood sugar should be controlled tightly so that the glycosylated hemoglobin is below 6.5 %.High glucose levels in the long run produces permanent damage to the filtering units of the kidneys. This involves tremendous patient commitment since it has to be a life long process. Life style modifications in diet, weight reduction, physical exercise and smoking cessation are steps taken in right direction.

Drugs and/or insulin therapy will be required in the majority of diabetics to control blood glucose. Blood sugar control also prevents damage to eyes, the cardiovascular and nervous systems.

Secondly, adequate control of blood pressure is of equal importance in preventing kidney disease. Diabetics are vulnerable to even minor elevations of blood pressure. It is recommended that the blood pressure be kept below 125/75 mm Hg in those with excess albumin leak in urine. This is achievable with salt restriction in food and blood pressure lowering drugs. Among them ACEi and ARB drugs have special properties which protect the kidneys from diabetic damage.

Thirdly cholesterol lowering therapy in the form of statin group of drugs is recommended since they also prevent onset of kidney disease. Patients with advanced kidney failure require special care in renal units.

They undergo dialysis therapy to remove the waste products from blood regularly. There are two methods of dialysis namely machine or hemodialysis and “water” or continuous ambulatory peritoneal dialysis. Kidney transplantation remains a viable option for many with advanced diabetic kidney disease. Inspite of tremendous progress in dialysis and kidney transplantation, the diabetics as a group do less well due to the widespread nature of damage to heart and nervous system.

Since the early stage of kidney disease is notoriously silent, a clarion call is hereby made to every diabetic to test his or her urine every 3 to 6 months for protein leakage. Early detection and prevention of further progress in Kidney disease will save life.

Dr.K.Sampathkumar

M.D.,D.M.,

Head & Senior Consultant,

Department of Nephrology,

Meenakshi Mission Hospital,

Madurai

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