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On diabetic kidney disease

Stay well-hydrated and don’t hold your urine. Avoid any medicines that may damage the kidneys (especially over-the-counter pain medications like ibuprofen or mefenamic acid).



One of the leading causes of kidney disease is diabetes. Many times, patients are referred to me when it is too late to save the kidneys and they have to be placed on dialysis. But this can be prevented with good blood sugar control and with regular follow-up with your doctor to keep an eye on your kidney function.

With diabetes, you have high blood sugars because your body does not make enough insulin or cannot properly use insulin, the hormone that regulates the amount of sugar in your blood. High blood sugar levels can then cause problems in many parts of your body — brain, eyes, heart, stomach, nerves and the kidneys. This is because the high blood sugar causes injury to small blood vessels all over the body.

When the blood vessels in the kidneys are injured, your kidneys do not work as well and cannot clean your blood properly. About 30 percent of patients with Type 1 diabetes and 10 to 40 percent of those with Type 2 diabetes will eventually suffer from kidney failure.

photograph courtesy of unsplash/ zohre nemati

When your kidneys are affected by diabetes, in the later stages your body will retain more water and salt than it should, which can result in weight gain and swelling in the legs and ankles. You may also have protein in your urine, and your urine may appear bubbly. Waste materials will also build up in your blood.

Diabetes may also cause damage to nerves that control bladder function and you may have trouble emptying your bladder. If urine remains in your bladder for a long time, you can develop a urinary tract infection from the rapid growth of bacteria in urine that has a high sugar level. This infection can also travel up to the kidneys. The pressure from always having a full bladder can back up and injure the kidneys.

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of pexels/nathan cowley
WEAKNESS and increasing fatigue are some of the symptoms of kidney disease.

In the early stages of diabetic kidney disease patients may not have any symptoms. The earliest sign may be albumin or protein in the urine that is seen on a test called a random urine protein:creatinine ratio, seen long before levels of creatinine or blood urea nitrogen (BUN) are seen to increase. If you have diabetes, it is important to have this urine test done at least once a year.

Other symptoms of kidney disease include:
•High blood pressure
• Ankle and leg swelling
• Leg cramps
• Weight gain
• Going to the bathroom more often at night
• Nausea and vomiting
• Loss of appetite
• Weakness and increasing fatigue
• Paleness and anemia
• Itching of the skin
• Less need for insulin or diabetes medications

As a person with diabetes, you should have your blood, urine and blood pressure checked regularly, at least once a year or more frequently as required by your doctor, usually every three months. Maintaining control of your diabetes and early treatment of high blood pressure can lower your risk of developing severe kidney disease.

Maintaining a healthy weight is also important. Remember that you only have two kidneys that clean your body of waste. Liken your body to a house, and the larger the house, the more difficult it will be to clean that house when there are only two people cleaning it, and they will get tired and run down sooner rather than later.

Other ways to keep your kidneys healthy is to get proper treatment for urinary tract infections and correct any problems in your urinary system. Stay well-hydrated and don’t hold your urine. Avoid any medicines that may damage the kidneys (especially over-the-counter pain medications like ibuprofen or mefenamic acid). Ask your doctor before taking supplements or herbals that supposedly treat kidney disease as they may be unnecessary and may cause even more damage.

Your doctor may also prescribe high blood pressure medicines called angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) that have been shown to help slow the loss of kidney function. A kind of medicine for diabetes called SGLT2 inhibitors may also be something you might be started on as it has been proven effective in delaying the progression of kidney disease in patients with diabetes. This type of medication is also now being used to treat patients without diabetes who have heart failure and kidney disease.

As with other medical conditions, recognizing the problem early and proper management is important in ensuring more favorable outcomes. Consult your doctor if you feel that you might be at risk for diabetic kidney disease.