Diabetic Kidney Disease

Diabetic kidney disease is also known as diabetic nephropathy. It is one of the main causes of kidney failure. It is a complication that occurs in about 40% of diabetic people. In this condition, the glomerulus, the site for filtration, is damaged. Usually, proteins are filtered, but in this condition, there is an abnormal leak of protein, namely albumin, into the urine.

There are usually no early symptoms of diabetic kidney disease. It is a disease that progresses over the years. As the function of the kidney deteriorates, the following symptoms may be experienced:

1. Loss of appetite
2. General body weakness 
3. Shortness of breath
4. Nausea 
5. Oedema of hands, face and feet
6. Insomnia
7. Muscle twitching 
8. Drowsiness 
9. Itching and extremely dry skin

There are some signs that your doctor may notice like:

1. Abnormalities in the regular heartbeat due to an increase in potassium in the blood
2. Proteinuria, proteins especially albumin, is leaked into the urine
3. Uncontrolled blood pressure 
4. Uremia is the accumulation of toxic waste products in the body

1. Diabetic kidney disease is a microvascular disorder that results from chronic diabetes. 
2. It can be caused by both diabetes type 1 and diabetes type 2.
3. Excessive blood glucose levels result in the formation of toxic reactive oxygen species. It leads to inflammation, fibrosis, apoptosis and cellular dysfunction. 
4. Other causes of diabetic kidney disease are heart disease, glomerulonephritis and congenital conditions like polycystic kidneys.

The risk factors of diabetic kidney disease include:

1. Susceptible factors include age, sex, ethnicity and race.
2. Initiation factors include hyperglycaemia and Acute Kidney Injury.
3. Progression factors include hypertension, obesity and diet.
4. Two most crucial risk factors are hyperglycaemia and hypertension. 
5. If you have poor glycaemic control with proteinuria, it is an independent predictor that your disease leads to End-Stage Renal Disease.
6. Other risk factors are smoking, history in the family, consuming food high in salt, no or minimal physical activity, active heart disease and high levels of cholesterol. 

Diabetic kidney disease is diagnosed by a healthcare professional on the basis of:

1. History: The doctor will question you on how long you've had diabetes when you started noticing oedema and if you experienced a loss in weight and appetite.
2. Clinical examination: The doctor will thoroughly examine you and look for the signs of renal disease.
3. Investigations: The doctor will ask you to run some blood and urine tests. These tests will confirm your diagnosis. The urine examination will show proteins in the urine. These tests will indicate the progression of your disease. The other investigations are BUN blood tests, serum creatinine blood tests, and kidney biopsies.

There is no absolute treatment for diabetic kidney disease. 

The treatment of diabetic nephropathy aims to:

1. Prevent the progression of kidney damage.
2. Prevent the development of cardiovascular diseases.

The treatment consists of keeping blood pressure and glucose levels under control, medications, and lifestyle modification.

1. Medications
   1. Medications that help in lowering blood sugar like SGLT2 inhibitors. The doctor may prescribe ACE inhibitors like ramipril, quinapril, and angiotensin receptor blockers (ARBs) for controlling blood pressure.
   2. The doctor may prescribe finerenone, a non-steroidal mineralocorticoid receptor antagonist that helps in reducing the risk of GFR decline and cardiovascular diseases. 
2. Lifestyle modifications
   1. The doctor may recommend dietary changes like limiting protein and salt intake. Consumption of healthy fats, less intake of potassium-rich food like banana, spinach and avocados, and less intake of food rich in phosphorus like milk, yoghurt and processed meat.
3. ESRD (End-Stage Renal Disease)
   1. In case of ESRD, you will need dialysis or a kidney transplant. Dialysis helps to filter the waste out of your blood.

If you don't seek treatment in time, you may develop complications gradually over a period of time. 

1. Fluid retention in your arms, legs, and lungs.
2. Hyperkalaemia increased potassium levels.
3. Cardiovascular diseases 
4. Imbalance of phosphorus and calcium in blood
5. Anaemia
6. Foot sores
7. Complication in pregnancy 
8. End-Stage Renal Disease

Disease progression

1. Diabetic kidney disease gradually progresses over time.
2. There are five stages of kidney disease. Stage 1 is the mildest, whereas stage 5 indicates severe damage to the kidney. 
3. Stage 5 kidney is not functional and requires transplant or dialysis.
4. The staging is determined on the basis of GFR.