#WorldKidneyDay: Kidney - a neglected organ in diabetes 

Dr Pradeep Gadge, a Diabetologist, Gadge Diabetes Centre, shares why Kidney should not be neglected in a diabetic patient

kidney structure

What are kidneys?

The kidneys are bean-shaped organs located near the middle of the back, just below the rib cage with one on each side of the spine. Kidneys are responsible for many essential regulatory roles, including filtering the blood to keep it clean and chemically balanced and erythropoietin hormone production.

One of the most important things is the removal of waste products from the blood, which comes from food and the normal breakdown of active tissues, such as muscles.

The kidneys also produce hormones that support the functions of the other organs, including hormones which support red blood cells’ production.

Does kidney play an important role in diabetes management?

All textbooks mention that the liver is an exclusive organ for glucose production in humans. Unfortunately, over the years, the kidney has been overlooked as a vital player in glucose metabolism.

Kidney has a key role in maintaining glucose homeostasis and is adversely affected by hyperglycaemia and insulin resistance in the setting of diabetes mellitus.

Although the liver is viewed as largely responsible for the increased release of glucose in diabetic patients, kidneys also increase the release of glucose into the circulation in the fasting state. Normally, every day, approximately 180 g of glucose is filtered by the kidneys.

Diabetes and hypertension have become the most common causes of ESRD (End-stage renal disease). Diabetes is a metabolic disease that causes renal failure, and renal failure increases the need for insulin in diabetic patients. High blood sugar levels damage the blood vessels in your kidneys. When the blood vessels are damaged, they don’t work as well. Many diabetic people also develop high blood pressure, which can also damage kidneys. The risk of low blood sugar occurs in someone who has both chronic kidney disease (CKD) and diabetes.

When kidney function declines, insulin and other diabetes medications remain in the system for a long time because of decreased kidney clearance. Sometimes patients may experience a loss of appetite that can lead to skipping meals or not eating enough.

It often causes a drop in blood sugar levels. Your doctor will customise the dose and timing of medications to go with diabetes and CKD patient’s daily routine and meal plan. Also, if the patient is on dialysis, they need to check their blood sugar more often.

It is important for patients to learn the symptoms of low blood sugar. Some of the symptoms of low blood sugar include headache, tiredness, weakness, sweating, hunger, and confusion.

Some people with low blood sugar may not always experience these symptoms. If the blood sugar level falls much low, a person may faint, have a seizure, or slip into a coma.

Unfortunately, the problem with kidney disease is that it remains symptom-free for long and when symptoms occur, it is usually too late to intervene. Only early screening and detection of kidney disease can help.

One can suspect the onset of kidney disease if there is swelling around ankles and eyes, and frothy urine indicates the loss of protein in the urine. As the disease progresses, a person may become weak, anaemic, find difficulty in concentrating, gets exhausted, develops loss of appetite, nausea, and starts vomiting.

As kidney disease advance, bones become brittle, and can easily break. Kidney diseases can be picked up by simple blood, and urine test. A urine test will reveal protein loss and blood will show a rise in urea and creatinine.

Another problem which we encounter in our country is self-medication, especially, the pain killers. People usually take painkillers, which are available over the counter, to relieve from pain.

The common painkillers are diclofenac and aceclofenac which people consume continuously. Long term ingestion of these pain killers leads to kidney disease. Diabetic patients are always recommended, whenever they visit doctors, they should inform about creatinine levels.

The measures diabetic patients need to take to protect the kidney include:

  • Avoid painkillers (NSAIDs & Cox 2 inhibitors).
  • Take care to avoid dehydration (vomiting and diarrhoea).
  • Control your diabetes and blood pressure.
  • Taking kidney protective medicines.
  • Avoid alcohol, smoking, and tobacco.
  • Alter your Insulin dose with your doctor’s advice if have loss of appetite.
  • Take safe painkillers if required (plain paracetamol).
  • Avoid using emulsion gels and spray that contains NSAIDS.

To keep our kidneys healthy, we need to take certain precautions, as prevention is better than cure. The easy ways to reduce the risk of developing these kidney diseases.

Keeping fit and active: Keeping fit helps to reduce your blood pressure and therefore reduces the risk of chronic kidney disease.

Keep regular control of your blood sugar level: About half of people, who have diabetes, develop kidney damage, so it is important for people with diabetes to have regular tests to check their kidney functions.

Kidney damage from diabetes can be reduced or prevented if detected early. It is important to keep control of blood sugar levels with the help of doctors or pharmacists, who are always happy to help.

Monitor your blood pressure: Although many people may be aware that high blood pressure can lead to a stroke or heart attack, few know that it is also the most common cause of kidney damage.

At 140/90mmhg and above, you should discuss the risks with your doctor and monitor your blood pressure level regularly. High blood pressure is especially likely to cause kidney damage when associated with other factors like diabetes, high cholesterol, and cardiovascular diseases.

Eat healthy and keep your weight in check: This can help prevent diabetes, heart disease and other conditions associated with Chronic Kidney Disease. Reduce your salt intake.

The recommended sodium intake is 5-6 grams of salt per day (around a teaspoon). In order to reduce your salt intake, try and limit the amount of processed and restaurant food and do not add salt to food. It will be easier to control your intake if you prepare the food yourself with fresh ingredients.

Do not smoke: Smoking slows the flow of blood to the kidneys. When less blood reaches the kidneys, it impairs their ability to function properly. Smoking also increases the risk of kidney cancer by about 50 per cent.

Do not take over-the-counter pills on a regular basis: Common drugs such as non-steroidal anti-inflammatory drugs like ibuprofen are known to cause kidney damage and disease if taken regularly.

Such medications probably do not pose significant danger if your kidneys are relatively healthy and you use them for emergencies only, but if you are dealing with chronic pain, such as arthritis or back pain, work with your doctor to find a way to control your pain without putting your kidneys at risk.

Check your kidney function if you have one or more of the ‘high risk’ factors:

  • You have diabetes.
  • You have hypertension.
  • You are obese.
  • You or one of your family members suffers from kidney disease.