Diabetes And Kidney: Understanding The Link And Its Consequences

Diabetes, a chronic metabolic disorder characterized by elevated blood glucose levels, affects nearly 422 million people in the world. While the impact of diabetes on various organs is well-known, one of the most serious and often overlooked complications is its effect on the kidneys. Diabetes is the leading cause of kidney disease with one out of every three adults with diabetes suffering from kidney-related issues.

This intricate relationship between diabetes and kidney function is a cause for concern, as diabetic nephropathy, or kidney disease, remains a leading cause of kidney failure or end-stage renal disease (ESRD). In India, it is estimated that the prevalence of diabetic nephropathy ranges from 40% to 62.3%.

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Diabetes and Kidney Connection

The kidneys play a pivotal role in maintaining the body's internal balance and filtering waste products and excess fluids from the blood. However, prolonged exposure to high blood glucose levels in diabetes inflicts damage to the delicate filtering units of the kidneys, known as nephrons. Additionally, diabetes can damage the kidneys through a variety of complex pathways, with most of this damage focused on the blood vessels responsible for filtering the blood to produce urine. Some of the ways in which this occurs:

Glomerular damage: High blood sugar levels can damage the glomeruli (tiny blood vessels within the nephrons of the kidney), reducing their ability to filter waste products.

Chronic inflammation and oxidative stress: These can damage the kidneys by triggering inflammatory responses and promoting the formation of free radicals.

Accumulation of advanced glycation end products (AGEs): The prolonged exposure of proteins to high blood sugar levels results in the formation of AGEs, which can impair kidney function and lead to inflammation and fibrosis.

Additionally, diabetes often coexists with hypertension (high blood pressure), creating a harmful synergy that further exacerbates kidney damage. Elevated blood pressure puts additional stress on the already compromised blood vessels in the kidneys, accelerating the progression of diabetic nephropathy. Moreover, uncontrolled hypertension can accelerate the progression of diabetic kidney disease.

As diabetes continues to damage the kidneys, their ability to filter waste and excess fluids declines. This reduction in kidney function can lead to the accumulation of toxins in the blood, causing a range of health issues. Individuals with diabetic nephropathy face an elevated risk of cardiovascular diseases, including heart attacks and strokes. In severe cases, diabetic nephropathy can progress to ESRD. This stage often necessitates dialysis or kidney transplantation to sustain life.

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Early intervention and management

Diabetic Kidney Disease is silent killer and most patients with diabetic kidney disease do not present with symptoms. Hence, regular monitoring of kidney function with simple tests such as urine albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR), can help with early detection and timely treatment. Moreover, adequate control of blood sugar levels in patients with diabetes through medication, diet, and lifestyle modifications is crucial for preventing and managing diabetic kidney disease. Controlling hypertension is equally important. Lifestyle changes and medications can help maintain blood pressure within the recommended range.

Diabetes poses a significant threat to kidney health. Understanding the mechanisms through which diabetes affects the kidneys is crucial for implementing effective preventive measures and management strategies. Through vigilant monitoring, lifestyle modifications, and therapy, patients with diabetes can mitigate the impact on their kidneys and maintain their quality of life.

About the Author: Dr. Sanjeev Gulati is the President, Indian Society of Nephrology and Principal Director ¨C Nephrology, Fortis Escorts, Delhi. All views/opinions expressed in the article are of the author.