How are Diabetes Mellitus and Kidney Related?

Diabetes Mellitus (DM), the commonest form of diabetes can affect kidneys in several ways – it can predispose to urinary tract infection, it can cause the reduced blood supply to the kidney by narrowing of the blood vessels supplying the kidneys and it can cause the death of a part of the kidney called papilla. Most importantly it can interfere with the function of filters within the kidneys (called glomeruli) resulting in progressively increasing protein leak in urine (proteinuria) and irreversible loss of kidney function over a period of several years (diabetic nephropathy). All these effects can lead to Chronic Kidney Disease (CKD). Rest of the discussion will focus predominantly on diabetic nephropathy as it is the commonest kidney involvement in DM.

How common is kidney failure due to diabetes mellitus?

DM is the commonest cause of CKD all over the world (and in India too). Around one-third of patients on dialysis for CKD have DM; also one third of patients having DM develop CKD.

How long does it take to cause kidney disease?

DM takes a minimum about 5 – 7 years to affect the kidney. The diagnosis of DM may be delayed if it is silent or not associated with the symptoms at the beginning; often we see patients with shorter duration of DM developing CKD related to DM.

What are the symptoms of kidney problem in a diabetic?

The early symptoms of kidney involvement in a diabetic patient are froth in urine and swelling of face, legs and abdomen. With worsening in kidney function, patients may have reduced urine output, increase in blood pressure, and loss of appetite, vomiting, tiredness, breathlessness and frequent episodes of low sugar (hypoglycemia). BUT PLEASE BE AWARE that the kidney involvement in a diabetic patient can be silent and all patients with DM should undergo periodic screening for urine and blood testing for proteinuria and serum creatinine. Diabetic eye disease (Diabetic Retinopathy) is invariably associated with diabetic nephropathy and patients who have diabetic retinopathy should undergo urine and blood tests for kidney disease.

How do you detect kidney damage?

Normally there is no protein leak in urine and the routine urine test will report this finding as nil or trace protein; DM over a period of years can cause closure of capillary loops within the filter units resulting first in progressively increasing proteinuria and subsequently progressive reduction in kidney function (kidney function can be calculated with certain mathematical formulae that require estimation of serum creatinine). It is possible to diagnose kidney involvement in DM at the earliest stage by doing urine test for microalbumin – this test will detect the presence of smallest quantities of albumin (a form of protein) even before routine urine test can detect its presence in urine.

What are the treatment options available once severe kidney failure happens?

Dialysis and Renal Transplantation are the available treatment options for patients with advanced CKD. There are two forms of dialysis: Hemodialysis (HD) and Continuous Ambulatory Peritoneal Dialysis (CAPD).

7 Early Warning Signs of Kidney Disease

While the only way to know if you have kidney disease is to get tested, but here are 7 possible signs that prove that you may have kidney disease. If you’re at risk for kidney disease due to high blood pressure, diabetes, a family history of kidney failure or if you’re older than age 60, it’s important to get kidney treatment at regular intervals. Be sure to mention any symptoms of kidney failure to your doctor.

• You’re more tired, have less energy or are having trouble concentrating

A severe decrease in kidney function can lead to a buildup of toxins and impurities in the blood. This can cause people to feel tired and weak. Another complication of kidney disease is anemia, which can cause weakness and fatigue.

• You’re having trouble sleeping

When the kidneys aren’t filtering properly, toxins stay in the blood rather than leaving the body through the urine. This can cause difficulty in sleeping. There is also a link between obesity and chronic kidney disease. So it’s important to keep a check of your weight.

• You have dry and itchy skin

Healthy kidneys do many important jobs. They help in removing wastes and extra fluid from your body. Dry and itchy skin can be a sign of the mineral and bone disease that often accompanies advanced kidney disease, when the kidneys are no longer able to keep the right balance of minerals and nutrients in your blood.

• You feel the need to urinate more often

If you feel the need to urinate more often, especially at night, this can be a sign of kidney disease. When the kidney filters are damaged, it can cause an increase in the urge to urinate.

• You spot blood in your urine

Healthy kidneys typically keep the blood cells in the body when filtering wastes from the blood to create urine, but when the kidney’s filters have been damaged, these blood cells can start to leak out into the urine.

• Your ankles and feet are swollen

Decreased kidney function can lead to sodium retention, causing swelling in your feet and ankles.

• You have a poor appetite

This can be a general symptom but a buildup of toxins resulting from reduced kidney function can be one of the causes.

Equipped with some of the finest kidney specialists and world-class amenities, NU Hospitals has positioned itself as one of the best kidney hospitals in India.

WHAT ARE THE SIGNS OF KIDNEY FAILURE?

Our kidneys are responsible for a variety of critical tasks, including blood filtration, regulation of blood pressure and hemoglobin levels. Kidney failure, also known as Chronic Kidney Disease (CKD), implies permanent damage which is both progressive and irreversible, to the kidneys. This disease impairs all the functions of the kidneys. This aggravates various other conditions such as blood pressure, anemia and bone disease.

What leads to kidney failure?

These common risk factors are:

• Diabetes: The foremost risk factor for CKD is diabetes. More often than not, diabetes is detected during the later stages, by which time other organs like the kidneys will have been affected.
• Hypertension: When uncontrolled, is a very high risk factor for kidney failure.
• Family History: A family history of renal dysfunction increases the risk of getting affected by chronic kidney disease.
• Infections: Recurrent urinary or kidney infection are also red flags for this disease.
• Over-the-counter medications: Popping pills without a qualified doctor’s supervision can not only wreak havoc with the kidneys, but also cause many other harmful side-effects.
• Glomerular disease: The presence of proteins in the urine is a tell-tale sign of an impending kidney damage, and if undetected and untreated, even kidney failure.

SYMPTOMS OF CHRONIC KIDNEY DISEASE

The common signs and symptoms include:

• Unexplained anemia
• Weakness
• Tiredness
• Problems getting sleep
• Chest pain
• Shortness of breath
• Loss of appetite
• Changes in urine
• Swelling of feet and the face
• Recurrent vomiting
• Nausea
• Unexplained weight loss

By the time the symptoms manifest themselves, it is usually too late and the kidneys are already severely damaged.  Therefore, it is vital not to wait for the symptoms to appear before a kidney checkup.

Kidney Failure Treatment Options

The treatment for CKD depends on the stage of the disease. The first three stages are early onset stages where the underlying cause must be treated and no specific medicines for kidney failure is administered. Quitting smoking is a very important step. Any instances of kidney or urinary infections must be looked into at the earliest.

In the advanced stages, the kidney function may be reduced by as much as 60-70%. In these cases, there should be more emphasis on controlling the blood pressure and things which are harmful to the kidneys.

There are certain medications such as Angiostein-Converting Enzyme (ACE) inhibitors and Angiostein Receptor Blockers which are proven to prevent further progression.

In stage 5, where the kidney damage exceeds 80-90%, medications do not have any effect and the only solutions are either dialysis, or, if the patient is fit enough, a kidney transplant.

Regular physical activity can help control the blood pressure, sugar levels, keeps the weight under control, all of which help in preventing further progression of this disease. Moderate exercises like walking, cycling etc. is definitely beneficial in the early stages.

As the kidney disease worsens beyond stage 4, the prospect of kidney failure becomes very real and it needs to be controlled with specific medications and certain dietary changes such as reduced salt and fluid intake and checking for any signs of heart problems. When the kidney fails, the only treatment options are kidney dialysis and transplant.

In the unfortunate eventuality of requiring a dialysis or transplant, a modern, well-equipped hospital makes a world of difference. NU Hospitals is a state-of-the-art kidney care hospital that has the all the necessary facilities and experienced specialists to successfully manage the most complex renal conditions.

Things You Need To Know About Chronic Kidney Disease

As per reports, 30 million people in the United States are living with Chronic Kidney Disease (CKD). The term ‘chronic kidney disease’ means lasting damage to the kidneys that can get worse over time. This is commonly called kidney failure, or end-stage renal disease. In case your kidneys fail, you’ll need dialysis or a kidney transplant in order to survive.

1. What causes chronic kidney disease?

Anyone can get chronic kidney disease. Risks vary from person to person. 

Some of the things that can increase the risk include:

• High blood pressure (Hypertension).

• Diabetes.

• Heart Disease.

• Hereditary factors.

• Being over 60 years old.

 2. Symptoms of chronic kidney disease:

chronic kidney disease usually gets worse with time and symptoms may not appear until your kidneys are inadequately damaged. In the later stages of chronic kidney disease, you may get to see symptoms that are caused by waste and extra fluid building up in your body.

Some of the symptoms are :

• muscle cramps.

• itching. 

• nausea and vomiting.

• swelling in your feet and ankles.

• trouble sleeping.

3. Treatments for chronic kidney disease:

Kidney damage is usually permanent. Although the damage cannot be treated, you can take steps to keep your kidneys as healthy as possible.

Some of the ways are:

• Keep your blood sugar under control.

• Follow a low-salt, low-fat diet.

• Make sure to exercise at least 30 minutes.

• Keep a check on your weight.

• No use of tobacco nor consuming alcohol.

NU Hospitals has been pioneering in Nephrology. Aided by a team of top Nephrologists in Bangalore, we offer optimal treatment options for the entire spectrum of kidney diseases. For those who are suffering from Nephrological problems, consider consulting with the best nephrologists for thorough and ethical diagnosis.

Kidney biopsy: Who would need it and why

A renal kidney biopsy is a medical procedure that requires extracting a small piece of kidney tissue for examination under a microscope. It’s usually a pathologist; a clinician specializing in diagnosing diseases—who examines the sample kidney tissue in a laboratory. From the diseased tissue, the pathologist can find out signs of a potential kidney disease or infection. If the patient has undergone a kidney transplant recently, doctors will perform a biopsy to figure out if the operation is successful, and if not- look into the reasons behind the failure of the procedure. The kidney tissue collected from the patient can show scarring, signs of infection, inflammation or unusual deposits of immunoglobulin. If a patient has chronic kidney disease or any other condition that leads to decreased kidney function over a given period of time—a renal kidney biopsy will reflect the pace at which the disease is progressing.

Supported by a team of top renal and transplant pathologists in Bangalore, NU uses two main ways of performing a renal kidney biopsy. The first one is called the percutaneous procedure where using ultrasound, a needle is used to collect kidney tissue. The second option is an open biopsy where, just like general surgeries- the skin is cut open to extract tissues from the diseased kidney. Besides providing some of the best kidney transplants in India, NU Hospitals also offer optimal post-operative care where the success of the transplant is monitored through kidney biopsies and other cutting-edge procedures. The team at NU has some of the best kidney transplant doctors in Bangalore who come with years of advanced medical practice.

Recovering from a renal kidney biopsy could depend on a number of factors. Having some of the most well experienced renal and transplant pathologists in Bangalore, NU offers the best kidney biopsies in the city. According to your physical fitness, immunity, and medical history, your doctor will recommend either an open biopsy or a percutaneous one. The open biopsy is generally offered to patients who have had problems with bleeding or blood clotting in the past or those who have only one active kidney. Patients are usually provided with a general anesthesia when they’re having an open biopsy. Post-biopsy, it’s normal to have some amount of blood in your urine and mild belly pain for up to 24 hours after the procedure. You should report to your physician straightaway if the condition persists for more than three days. The patient is allowed to resume their normal diet and usual daily activities within a week of the biopsy. The team at NU is backed by some of the best kidney transplant doctors in Bangalore who will provide you the most hassle-free, high-end biopsies at economical rates.