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My Diabetic Kidneys and Me

In the Philippines, the prevalence of diabetes according to the NNHES (National Nutrition Health Survey) study is 4.8%. NSO (National Statistics Office) projects that there would be 74 million adult Filipinos in 2010. Therefore, there could be 3.6 million Filipinos who have diagnosed diabetes.

Diabetes is a disease wherein your body does not make enough insulin or cannot use insulin properly to regulate the amount of sugar in the body. If blood sugar goes uncontrolled, it cas cause damage to the heart, blood vessels, eyes, feet, nerves, and kidneys. Your kidneys are important because they remove waste products from the body by filtering blood and producing urine. In addition to removing drugs and toxins, they also balance the body fluids, release hormones that control blood pressure, regulate salts (sodium, potassium, phosphorus, calcium), promote production of red blood cells, and keep the bones healthy.

Diabetes can caus damage by affecting the blood vessles. With high blood sugar levels, the vessels become clogged and narrow leading to decreased blood supply to the kidneys. About thirty percent of diabetic patients may get chronic kidney disease and the risk for getting kidney disease becomes greater if the patient is older, has high blood pressure, or has a family member with kidney disease.

To know if your kidneys have been damaged by diabetes, check for the following signs and symptoms:

  1. Frequent urination at night (>3x/night) and/ or bubbling urine. The earliest sign of kidney disease in a person with diabetes is the presence of protein (specifically, albumin) in the urine, which in significant amounts, can cause bubbling.
  2. Increase in blood pressure, weight gain, swelling around the eyes and leg. With kidney damage, your body will retain more salt and water than it should.
  3. Insomnia, fatigue, itchiness, nausea, vomiting, and lack of appetite. Your kidneys are your body’s “waste machines” and when they are damaged, they cannot clean your blood properly and waste products accumulate in your blood causing these symptoms.
  4. Paleness and weakness. Kidneys produce a substance called erythropoietin and this is needed by the body to produce red blood cells. Thus, with kidney disease, patients develop anemia.

Consult your doctor if you have any of these signs and symptoms. Moreover, even if you don’t have any of the above signs and symptoms, you should have your urine and blood checked at least once a year or as recommended by your doctor. This is because chronic kidney disease (CKD) is a silent disease and early kidney disease rarely has symptoms. Routine screening for kidney disease therefore is important. With these basic tests, your doctor can tell you how your kidneys are working:

  1. Urine micral test. This is a sensitive urine test that can detect small amount of protein (known as microalbuminuria) long before there is evidence of kidney disease in the usual blood tests. Protein is not normally found in the urine. When the kidneys are damaged, protein spills from blood into the urine.
  2. Creatinine. Creatinine is a waste product that is usually removed by the kidneys from the body and eliminated through the urine. When the kidneys are damaged, creatinine levels increase in the blood. You can get an estimate of your kidney’s filtering ability which is the main function of your kidney by computing for your kidney’s glomerular filtration rate (GFR). GFR is computed using a mathematical formula which also includes your sex, age, height, weight, and race. It is the basis for establishing the stage of CKD. The higher the creatinine, the lower the GFR, and the worse your kidney function is.

Your doctor will plan and modify treatment according to the stage of kidney disease. If your kidney disease is caused by diabetes, then your doctor will give a diagnosis of CKD secondary to diabetic kidney (formerly known as diabetic nephropathy). CKD is defined as having some type of kidney abnormality such as presence of protein in the urine, and/or having decreased kidney function for 3 months or longer. Without proper treatment, the time between the start of diabetic kidney damage to end stage kidney failure is about 5 to 7 years. However, early detection and treatment can prevent this from happening.

Here are the ways to prevent you from getting kidney disease from diabetes:

  1. Talk to your doctor about your chances of getting kidney disease and see your doctor as often as you are told.
  2. Control your blood sugar level.
  3. Control your blood pressure level.
  4. Follow your diet for diabetes.
  5. Get regular exercise.
  6. Avoid alcohol.
  7. Do not smoke.

However, if you already have kidney disease, your doctor will then determine your CKD stage and work with you to keep your kidneys working as long as possible. The lower your stage when you begin treatment, the more the chances of success in trying to delay progression to a later stage. You may be referred to a kidney doctor (nephrologist) and a dietitian who will work along with you to make your kidneys last longer. Here are the steps you need to take:

Control your blood sugar.
This can be done through exercise, diet, and by taking medications (oral hypoglycemic agents and/ or if needed, insulin). Your doctor will request for a test known as HbA1c (glycosylated hemoglobin) which will indicate your blood sugar control in the past three months before the test was taken. Current recommendations advise a target HbAlc of 7% or lower. As kidney function worsens, there is a need for fewer amounts of insulin or oral antidiabetic pills. This is because damaged kidneys result in less breakdown of insulin.

Control blood pressure.
For people with diabetic kidney disease, the blood pressure should be less than 130/80. If you have protein in your urine, the target BP is 125/75 or lower. In a lot of cases, more than one antihypertensive medication may be needed to reach this target. Your doctor will probably give you a high blood pressure medication known as ACE (angiotensin converting enzyme) inhibitor or an ARB (angiotesin receptor blocker) since studies have shown that these medications, aside from lowering blood pressure, can also decrease protein in the urine and retard progression of kidney failure. These medications may also be given to patients with diabetic kidney disease even if their blood pressure is normal. Limiting the amount of salt in the diet will also help control high blood pressure.

Decrease protein intake.
Studies have shown that limiting your protein intake can also slow loss of kidney function. Protein intake recommendations range from 0.6-0.8 gram per kg of body weight. However, it is advisable that you consult a dietitian before you go on this type of diet.

Treat infections early.
Any infection can cause additional damage to your kidneys. Urinary tract infections (UTI) in particular, should be treated early. See your doctor if you have the following symptoms: fever, pain while urinating, lower abdominal or flank pains, blood in urine, frequent need to urinate, and strong odor in urine.

Avoid medicines that can cause further kidney damage.
Once you have kidney disease, it is recommended to check with your doctor first before taking any medicines or herbal supplements. A lot of drugs and supplements are metabolized by our kidneys. Certain antibiotics and some over-the-counter medicines like pain medicines can be toxic to the kidneys, causing permanent damage. Dosages of most medications need to be adjusted according to the level of kidney function.

Control cholesterol.
High cholesterol can cause blood vessels to become clogged and further impair blood supply not only to your kidneys but also to your heart and brain. If the cholesterol and other fatty substances in your blood (known as lipids) are high, you may need to be given anti-cholesterol medications called statins to lower them.

The most effective way of slowing the loss of kidney function is by controlling your blood sugar and blood pressure. However, if CKD progresses, and your GFR decreases to less than 15m1/min (stage 5), your doctor will already recommend dialysis and/or transplant. At this level, the kidneys are no longer able to support your body in a reasonably healthy state. Dialysis and/or kidney transplant is needed to replace the work of your failed kidneys. In most cases when your GFR decreases to below 20, your doctor will usually advise that you arrange for a permanent access for dialysis.

Diabetes is the leading cause of chronic kidney disease in the Philippines. Ask your doctor regarding your chances of having diabetic kidney disease. Diabetic patients should always know their GFR number. Having diabetes does not always mean you will have kidney disease and your kidneys will fail. It is important to choose a doctor that you trust and are most comfortable with and who can plan your treatment with you. If steps are not taken to slow the worsening of kidney function, the kidneys may eventually fail and either dialysis or kidney transplant would be needed to Iive.

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