Diabetes, a chronic metabolic disorder characterized by high blood glucose levels, affects nearly 422 million people worldwide. 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, and one in three adults with diabetes suffers from kidney-related problems.
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, the prevalence of diabetic nephropathy is estimated to range between 40% and 62.3%.
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Connection between diabetes and kidneys
The kidneys play a critical role in maintaining the body’s internal balance and filtering waste products and excess fluid from the blood. However, prolonged exposure to high blood glucose levels in diabetes damages 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 concentrated in the blood vessels responsible for filtering blood to produce urine. Some of the ways this happens:
Glomerular damage: High blood sugar levels can damage the glomeruli (small blood vessels within the nephrons of the kidney), reducing their ability to filter waste products.
Chronic inflammation and oxidative stress: can damage the kidneys by triggering inflammatory responses and promoting the formation of free radicals.
Accumulation of advanced glycation end products (AGEs): Prolonged exposure of proteins to elevated blood sugar levels results in the formation of AGEs, which can affect 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 pressure on already compromised blood vessels in the kidneys, accelerating the progression of diabetic nephropathy. Additionally, uncontrolled hypertension can accelerate the progression of diabetic kidney disease.
As diabetes continues to damage the kidneys, their ability to filter waste and excess fluid decreases. This reduction in kidney function can cause toxins to build up in the blood, causing a host of health problems. People 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 requires dialysis or kidney transplant to sustain life.
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Early intervention and management
Diabetic kidney disease is a silent killer and most patients with diabetic kidney disease have no symptoms. Therefore, regular monitoring of kidney function with simple tests such as urine albumin-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) can help with early detection and timely treatment. Additionally, proper control of blood sugar levels in patients with diabetes through medications, diet, and lifestyle modifications is crucial to preventing and managing diabetic kidney disease. Controlling hypertension is equally important. Lifestyle changes and medications can help keep blood pressure within the recommended range.
Diabetes represents a major threat to kidney health. Understanding the mechanisms through which diabetes affects the kidneys is crucial to implementing effective preventive measures and management strategies. Through careful 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 of the Indian Society of Nephrology and Senior Director of Nephrology at Fortis Escorts, Delhi. All views/opinions expressed in the article are those of the author.
Categories: Health
Source: vtt.edu.vn