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Tuesday , 26 March 2019
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Kidney a neglected organ in diabetes

What are kidneys?

The kidneys are bean-shaped organs that are located near the middle of the back, just below the rib cage with one on each side of the spine. Kidneys are responsible for many essential regulatory roles, including filtering the blood to keep it clean and chemically balanced & production of a hormone called erythropoietin. One of the most important is the removal of waste products from the blood, which come from food and the normal breakdown of active tissues, such as muscles.

The kidneys also produce hormones that support the function of other organs in the body, including hormones erythropoietin that support the production of healthy red blood cells.

Does kidney plays important role in diabetes management?

In all textbooks it is mentioned that liver is the exclusive site of glucose production in humans.  Unfortunately, over the years the kidney has been overlooked as an important player in glucose metabolism. Kidney has a key role in maintaining glucose homeostasis and is adversely affected by hyperglycemia and insulin resistance in the setting of diabetes mellitus. Although the liver is commonly viewed as being largely responsible for increased release of glucose in diabetic patients. Kidneys also increases release of glucose into the circulation in the fasting state.  Normally each day, approximately 180 g of glucose is filtered by the kidneys.

Diabetes and hypertension have become the most common causes of ESRD (End stage renal disease). Diabetes  is a metabolic disease that causes renal failure, and renal failure increases the need for insulin in diabetic patients. High blood sugar levels damages the blood vessels in your kidneys. When the blood vessels are damaged, they don’t work as well. Many people with diabetes also develop high blood pressure, which can also damage  kidneys. The greatest risk of low blood sugar occurs in someone who has both chronic kidney disease (CKD) and diabetes. When kidney function declines insulin and other diabetes medications remain in the system longer because of decreased kidney clearance. sometimes patients may experience a loss of appetite that can lead to skipping meals or not eating enough. This often causes a drop in blood sugar levels. Your doctor will customize the dose and timing of medications to go with the diabetes and CKD patient’s daily routine and meal plan. Also, if patient is on dialysis, they need to check their blood sugar more often.

It is important for patients to learn the symptoms of low blood sugar. Some of the symptoms of low blood sugar include: Headache, Tiredness, Weakness, Sweating, Feeling shaky, hungry, Confusion. Some people with low blood sugar may not always experience these symptoms. If the sugar level falls too low, a person can sometimes faint, have a seizure or go into a coma.

unfortunately problem with kidney disease is that it remains symptom free for long and when symptoms occur, it is usually too late to intervene. Only early screening and detection of kidney disease help.

One  can  suspect  onset of kidney disease  if  there is swelling especially  around  ankles  and  around  eyes  and  frothy  urine   indicating  loss of  protein  in  urine. As  the   disease progresses , person  becomes  weak , anemic ,  finds  difficult  to  concentrate , gets  exhausted  easily , develops  loss of  appetite , nausea  and  vomiting .  As  kidney  diseases  advance , bones  become  brittle  and   can  easily  break.  Kidney  diseases  can  be  picked  up  easily  by  simple blood  and  urine  tests . Urine  test  will  reveal  protein loss and  blood  will  show rise  in  urea  and  creatinine.

Why diabetic patients needs to be caution while taking any painkillers?

Another problem which we encounter in our country is self-medication especially the pain killers. People usually pop up  painkillers, which are easily available over the counter to relive from pain. The most common painkiller are diclofenac and aceclofenac which people tend to take for continuous days and weeks. Long term ingestion of these pain killers leads to kidney disease. Diabetic  patients are always recommended whenever they are visiting their doctors they should be informed about creatinine levels, to their doctor.

The measures diabetic patients needs to  take to protect kidney include

  • strictly avoid painkillers (nsaids & Cox 2 inhibitors)
  • take care to avoid dehydration (vomiting and diarrhoea)
  • control your diabetes and blood pressure
  • taking kidney protective medicines
  • avoid alcohol, smoking and tobacco.
  • alter your Insulin dose with your doctor’s advice if have loss of appetite.
  • take safe painkillers if required (plain paracetamol)
  • avoid using emulsion gels and spray that contains nsaids

To keep our kidneys healthy, we need to take certain precautions, as prevention is better than cure. The easy ways to reduce the risk of developing these kidney disease.

1) Keeping fit and active- Keeping fit helps to reduce your blood pressure and therefore reduces the risk of Chronic Kidney Disease.

2) Keep regular control of your blood sugar level- About half of people who have diabetes develop kidney damage, so it is important for people with diabetes to have regular tests to check their kidney functions. Kidney damage from diabetes can be reduced or prevented if detected early. It is important to keep control of blood sugar levels with the help of doctors or pharmacists, who are always happy to help.

3) Monitor your blood pressure- Although many people may be aware that high blood pressure can lead to a stroke or heart attack, few know that it is also the most common cause of kidney damage.  At 140/90mmhg  and above, you should discuss the risks with your doctor and monitor your blood pressure level regularly. High blood pressure is especially likely to cause kidney damage when associated with other factors like diabetes, high cholesterol and Cardio- Vascular Diseases.

4) Eat healthy and keep your weight in check- This can help prevent diabetes, heart disease and other conditions associated with Chronic Kidney Disease. Reduce your salt intake. The recommended sodium intake is 5-6 grams of salt per day (around a teaspoon). In order to reduce your salt intake, try and limit the amount of processed and restaurant food and do not add salt to food. It will be easier to control your intake if you prepare the food yourself with fresh ingredients.

5) Do not smoke- Smoking slows the flow of blood to the kidneys. When less blood reaches the kidneys, it impairs their ability to function properly. Smoking also increases the risk of kidney cancer by about 50 percent.

6) Do not take over-the-counter pills on a regular basis- Common drugs such non-steroidal anti-inflammatory drugs like ibuprofen are known to cause kidney damage and disease if taken regularly. Such medications probably do not pose significant danger if your kidneys are relatively healthy and you use them for emergencies only, but if you are dealing with chronic pain, such as arthritis or back pain, work with your doctor to find a way to control your pain without putting your kidneys at risk.

7) Check your kidney function if you have one or more of the ‘high risk’ factors:-

-you have diabetes

-you have hypertension

-you are obese

-you or one of your family members suffers from kidney disease

By: Dr Pradeep Gadge, leading Diabetologist, Gadge Diabetes Centre

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