Monday, August 29, 2011

Don’t let your kidneys fail you

By Dr Vikram Kalra Deccan Chronicle

Diabetes is the common thread running between Basic Instinct star Sharon Stone and Miss America, Vanessa Williams. And with this disease can come the risk of diabetic nephropathy. This is the single most common cause of end-stage renal disease (ESRD) throughout the globe accounting for a whopping 25-45 per cent of all patients enrolled in ESRD programmes requiring renal replacement therapy.

A major cause of morbidity and mortality not only in the developed world, but also in developing countries, the burden of chronic kidney disease (CKD) in India cannot be assessed accurately. What we do know is that about 10 per cent of the new ESRD cases get renal replacement therapy, as the therapy is expensive and there is a scarcity of dialysis and renal transplant centres. Thus, the screening of high-risk individuals for CKD is the best bet.

The CKD link
To begin with, each kidney contains up to one million nephrons — the filtering units of the kidneys. Inside a nephron is a tiny set of looping blood vessels called the glomerulus. Damage to these filters caused by diabetes is called diabetic kidney disease — also known as Diabetic Nephropathy. The problem eventually leads to large amounts of protein in the urine, high blood pressure and declining kidney functions. Even when drugs and a diet are able to control diabetes, the disease can lead to nephropathy and kidney failure.

It is possible for individuals to have serious kidney damage without being aware of it. There may be no specific symptoms of diabetic kidney disease until the kidneys fail completely. The early signs and symptoms that could help include: albumin (a type of protein) in the urine, tiredness and swollen ankles.

However, the symptoms related to kidney failure usually occur only in late stages of the disease, when the kidney function has diminished to less than 25 per cent of the normal capacity. For many years before that point, kidney disease related to diabetes exists as a silent process.

The earliest and the most simple method to detect kidney disease in diabetics is to check for microalbuminuria (albumin in very small quantity in the urine). All diabetics should follow up with the nephrologist for treatment at this stage, as this is a reversible stage of kidney disease in diabetics.

The possible causes
Diabetic nephropathy is a long-term complication of diabetes, but only 20-30 per cent of people with diabetes will develop diabetic nephropathy — it is not entirely understood why this happens. The factors that increase the risk of kidney disease include high blood pressure, high blood glucose levels (particularly in the early stages of diabetes), smoking, a family history of diabetes and diabetic nephropathy and obesity, high cholesterol and triglycerides in the body.

If a person’s kidneys are about to fail, they might experience symptoms such as tiredness, nausea and vomiting, fluid retention and breathlessness. They may also find that they need less insulin than usual. When the kidneys fail, wastes and fluids will accumulate in the body and dialysis or a kidney transplant is needed. People with diabetes who receive transplants or dialysis may experience more medical problems and other diabetic complications.

Detection and prevention
Some people with diabetic kidney failure are suitable for a combined kidney and pancreas transplant. If successful, they regain normal kidney function and have normal blood sugar levels meaning they can stop using insulin.

There are also treatments which may help to delay kidney failure. It is usually necessary to start these treatments as soon as the doctor notices any of the early signs or risk factors.

Here are some ways to help prevent kidney damage

  • Ensure that your diabetic control is excellent — follow your doctor’s advice regarding insulin injections, medicines, diet, exercise, and monitoring your blood sugar.
  • Control high blood pressure. Have your blood pressure checked several times a year and preferably monitor it yourself at home. If your blood pressure is high, follow your doctor’s plan for keeping it at normal levels. Drugs used to lower blood pressure (anti-hypertensive drugs), especially certain groups of drugs called ACI inhibitors and A2 receptor antagonists, can slow down the progress of kidney disease.
  • It is important to consult a doctor or dietician to determine a suitable diet.
  • Stop smoking or don’t start smoking.
  • Have urine infections treated immediately.
  • Control blood cholesterol and triglyceride levels with diet and medication.
  • Drink alcohol in moderation; preferably switch over to red wine.
  • Aim to achieve and maintain your weight within the correct range for your height and age.
  • Exercise regularly.
  • Have your urine, blood and blood pressure checked regularly by your doctor.

- The writer is Consultant Nephrology, Fortis Escorts Heart Institute, New Delhi

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