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How to protect your Kidneys from Diabetes

Before you know about protecting your kidneys from diabetes, here’s a small question. Where are the kidneys located? See answer below*

For most of us, the kidneys are like the crew of movies that work behind the screen (only to be seen in the end on the credits list). They do their job and as long as they do not bother you, it’s out of your conscious realm. However, this is not the case with people who have diabetes. Running a risk of diabetic nephropathy, they have to take extra precautions.

Though diabetes is a leading contributor to most end-stage kidney diseases, people with diabetes are not totally aware of the connection between diabetes and kidneys.

And for those of you who just have a hazy memory of the biology class in your schooling days, here are a few facts that prove that your kidneys are indeed made of great stuff. They are above and beyond!

All about kidneys:

These bean-shaped organs have multiple functions. They are vital for removal of waste particles from the blood.

Functions of kidneys:

Excretion of waste from the blood. The kidneys filter out waste substances like urea, unwanted salts, and other toxins created during the metabolism.
Maintain water levels in the body.
Blood pressure regulation.
Regulation of red blood cells.
Regulation of pH (acid-base levels) and ion concentrations (potassium, sodium, calcium).
Production of hormones called erythropoietin and renin.

Some other interesting facts about the kidneys:

The right kidney is smaller than the left kidney.

They filter two gallons of blood every hour.

Each kidney contains more than million tiny filters called nephrons that filter out waste materials from the blood and are released in the form of urine.

If the nephrons of both kidneys are placed alongside each other, they can stretch up to 16 kilometers.

Even if the functional capacity of the kidneys are reduced by 75%, they can function properly as they have the capacity to enlarge.

Though people are born with two kidneys, they can survive with one functional kidney.

Kidneys produce active vitamin D, which is responsible for absorption of calcium.

The adrenal glands located above the kidneys produce cortisol and adrenaline.

When mineral salts along with calcium accumulate, they lead to kidney stones (calculi).

When a person gets dehydrated, the kidneys reduce the production of urine until the body is hydrated.

Most kidney diseases are caused due to high blood pressure, diabetes, and medications like OTC painkillers.

*Location of the kidneys: The kidneys are located in the upper abdomen against the back muscles (posterior abdominal area).

Common diseases of the Kidneys:

Here is a list of some common kidney diseases.

  • Urinary tract infection
  • Kidney stones.
  • Polycystic kidney disease.
  • Glomerulonephritis.
  • Alport syndrome.
  • Nephrotic syndrome.
  • Nephritis.
  • Acute kidney injury.
  • Diabetic nephropathy.
  • Chronic kidney disease.

Symptoms of kidney disease:

Kidney disease generally manifests in the form of the following symptoms.

  • Anuria (less than 50 milliliters of urine per day).
  • Oliguria (smaller amounts of urine).
  • Polyuria (large volumes of urine).
  • Hematuria (blood in urine).
  • Painful urination.
  • Change in the frequency of urination (can be a symptom of diabetes in case of increased urination).

These symptoms are often accompanied by other symptoms like fever, nausea and vomiting, lack of appetite, edema in the extremities (especially the feet and legs) and abnormalities of the nails.

Diagnostic tests done for kidney diseases:

  • Urinalysis.
  • CBC.
  • Urine culture test.
  • Abdominal x-ray and ultrasound.
  • Serum creatinine and albuminuria.
  • BUN (blood urea nitrogen test).
  • Fasting glucose test.
  • Kidney angiogram.
  • Kidney biopsy.

Prevalence of kidney diseases in India:

Chronic kidney disease is a huge healthcare burden for the country. As with many other noncommunicable diseases, chronic kidney diseases are caused due to numerous lifestyle choices and other factors.

Chronic kidney diseases are mainly caused due to improper management of hypertension, and diabetes. Though the prevalence is higher in patients above 65 yrs of age, there is a significant increase in the age groups of 45-64, and 22-44.

It is also a fact that patients with chronic disease are at a higher risk of cardiovascular diseases. Moreover, many chronic kidney disease patients do not have the best outcomes.

Chronic kidney disease leads to end-stage kidney disease that needs dialysis or hemodialysis. Some patients might even need a kidney transplantation.

Since diabetes and kidney diseases have a strong connection, it is very important for diabetics to understand the connection between diabetes and kidney function in order to avoid diabetic nephropathy.

Diabetes and Kidneys:

It is a known fact among the medical communities that nearly 60% of all chronic kidney diseases are due to diabetes and hypertension. Added to that, most chronic kidney patients had very high HbA1c values.

Diabetes is a metabolic disorder that affects all the vital organs of the body including the kidneys. Patients with high blood sugar symptoms witness increased urination which means that kidneys are working harder to flush out the excess glucose.

The kidneys contain millions of tiny capillaries (blood vessels) that perform the job of filtering the blood. When blood flows through these capillaries, the waste particles are squeezed out of them to be flushed out in the form of urine.

In people who experience high blood sugar symptoms, the functionality of the filtering system is compromised as there is a need to filter more blood than usual. With this extra strain, the glomeruli (cluster of small capillaries) tend to give way and the albumin leaks into the urine. This is called albuminuria and is witnessed in the diagnostic test microalbuminuria.

What is diabetic nephropathy?

Diabetic nephropathy is a kidney-related disease that can lead to end-stage kidney disease and hospitalization due to the compromised ability of the kidneys to filter out waste substances.

Diabetic nephropathy manifests when the symptoms of high blood sugar persist for a long time in cases of improper management of diabetes.

Diabetic nephropathy can affect both type 1 and type 2 patients. The risk increases in patients who have hypertension and diabetes. Smoking, and hyperlipidemia are also risk factors for diabetics.

Complications include:

  • End-stage kidney failure.
  • Cardiovascular diseases.
  • High blood pressure.
  • Hyperkalemia(increased levels of potassium).
  • Damage to the nerves and blood vessels.
  • Erectile dysfunction.
  • Edema in the extremities (feet, legs, arms).

Symptoms of Diabetic nephropathy:

  • Swelling in the feet, ankles, and arms.
  • Increased urge to urinate.
  • Lack of blood pressure control.
  • Lack of appetite.
  • Fatigue.
  • Nausea and vomiting.
  • Elevated serum albumin.
  • Difficulty concentrating.

If you are a diabetic and notice any of these symptoms, it’s time to consult a doctor immediately.

Stages of diabetic nephropathy:

The progression of diabetic nephropathy is measured by GFR (Glomuler Filtration Rate). GFR is a good parameter to measure the kidney function.

In stage 1, the GFR is 90 or more. This means the kidney damage is in the nascent stage, but the functionality is retained.

In stage 2, the GFR is 89 to 60. This means that the functionality of the kidneys is reduced and there is some damage to them.

In stage 3, the GFR is 59 to 30. Damage to kidneys is half and there are other complications.

In stage 4, the GFR drops to a range of 29-15 and there is severe kidney damage.

In stage 5, the kidney are totally nonfunctional and the patient requires dialysis. The GFR drops below 15.

How to protect your kidneys from diabetic nephropathy

It is very important for a diabetic to understand how to control diabetes holistically using diet, exercise, and medications effectively. Only with proper glycemic control and maintaining the target HbA1c levels, can one reduce the risk of kidney damage.

If you witness any of the above mentioned symptoms of diabetic nephropathy, you should consult your diabetologist immediately for further investigations.

It is very important to consult a dietician for better management of diabetes with proper diet. With a diabetes diet chart provided by a professional dietician, one can avoid foods that increase high blood sugar levels, and maintain normal sugar levels.

Controlling blood pressure is also vital to prevent damage to the capillaries of the kidneys. ACE inhibitors, and angiotensin-II receptor antagonists are prescribed for prevention of kidney damage.

Unless prescribed by your physician, never take anti-inflammatory medications.

Quit smoking! Smoking increases kidney damage.

Dietary supplements like vitamin C, vitamin E, and antioxidants should be taken with the advice of your diabetologist.

Quit alcohol consumption.

Get good physical activity.

It is very important to note that you should not restrict diabetes management to medications alone. Regular self-monitoring of blood glucose levels, consuming foods according to the diabetes diet chart, and appropriate physical activity are necessary along with medications.

With these activities, the symptoms of high blood sugar are reduced and with glycemic control, the risk of diabetes complications are further reduced.

Diabetes Diet Chart for patients with diabetic nephropathy:

Consume low protein diet including egg whites, fish, and lean meat to compensate for proteinuria (loss of protein in urine).
Avoid foods that contain high potassium levels like avocados, bananas, coconut water, and tea.
Foods like pumpkins, sweet potatoes, and potatoes can be consumed.
Oils like peanut oil and olive oil are healthy choices.
Restrict salt intake.
Foods that contains high levels of uric acid should also be avoided.

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