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Why does diabetes cause kidney failure?

Endocrinology Nephrology

My grandma has diabetes, and the doctor has warned her that if she does not improve her diabetic control, she is likely to get kidney failure. 

DOCTOR’S ANSWER (2)

Hi, I am sorry to hear that your grandmother has diabetes and she is at risk of developing diabetic kidney disease (aka diabetic nephropathy); which means diabetes affecting the kidney, damaging it and potentially leading to kidney failure.

In fact, diabetes is the most common cause of total kidney failure worldwide and in Singapore. Around 40% of patients with diabetes develop kidney problems. Many of them can progress to total kidney failure, needing dialysis or kidney transplant to remain alive.

Besides, patients with diabetic kidney disease and even more with total kidney failure are susceptible to many medical complications, including heart attacks, strokes and disabilities, which can affect dramatically the length and quality of life of the patients who suffer them.

My intention is not to scare you but to create awareness of the potential risks, even if at present the disease seems not to be advanced. But we all know that prevention is better than cure. Thus, I concur with your doctor recommending better blood sugar control to prevent the appearance and/or the progression of diabetic kidney disease into total kidney failure. In addition, good blood sugar control can also help minimising the risk of other complications like blindness and amputations; certainly, it will protect the heart and can reduce blood cholesterol and uric acid and help in losing or maintaining weight.

But how does diabetes cause kidney problems?

Persistent high blood levels of sugar (poor diabetic control) progressively damages many organs of the body which are rich in blood vessels like the heart, eyes, brain and kidneys, and affect the circulation to the limbs. Simplistically, the excess of blood sugar kind of “caramelises” inside the blood vessels and tissues and that causes inflammation, damage and scarring.

Specifically, in the kidney, high blood sugar progressively damages the filters of the kidneys (the ones that clean the blood), and patients start leaking proteins in the urine. If poor sugar control remains, it can lead to progressive scarring of the kidneys, losing their capacity to clean the blood and control body water, with consequent elevation of blood creatinine (a marker of kidney disease) and toxins in the blood.

Never is too late to improve her sugar control. It could prevent the occurrence of diabetic kidney disease, or slow its progression or minimise the impact it has in her health. And the protection of her kidneys will be more impactful if any other little problems that she might have can be controlled and optimised like high blood pressure, overweight, high cholesterol, etc. Doctors also can give some medications to protect, at least partially, the kidneys, the so-called “renin-angiotensin-aldosterone blockade”, and occasionally and if necessary advise on a diet low in protein and salt, and recommend avoidance of bad habits like smoking.

Diet plays a crucial role in the management of diabetic patients to obtain better sugar control, even if taking medications. Medications are necessary for many patients with diabetes, but they are not a substitute for diet control: they are complementary. But many patients think that by taking medications their diet does not need to be controlled. On the contrary, medications will work better if eating a healthier diet; and in fact, many patients can control her diabetes with diet only. 

Many patients find difficult to control their diet, as indeed diet and eating are pleasures and social activities, but with good support and advice from doctors and dieticians, it is possible to adopt a healthier diet and improve blood sugar control. And even this can be achieved without excessive restrictions, with a personalised diet; in order to foster the sustainability of the diet regimen and of the blood sugar control.

Dr Francisco, wishing your grandmother the best possible health. 

333 views 11 Jan 2019

Diabetes mellitus is a condition in which the body is unable to properly use and store sugar (glucose), resulting in blood sugar level rising higher than normal.

Type 2 diabetes mellitus (T2DM), which comprises 90% to 95% of all cases of diabetes, occurs because the body (in particular, the pancreas) does not produce enough insulin and the body is also unable to use insulin properly (insulin resistance).

High blood sugar levels if not controlled over years can lead to damage to the various blood vessels in the body.

Damage to the small blood vessels supplying the kidneys can result in damage to the kidneys, leading to diabetic kidney disease. Diabetic kidney disease usually causes no symptoms until at least 75% of the kidneys' function is lost.

To detect diabetic kidney disease, urine test that measure the protein level in the urine and blood test to evaluate the level of kidney function should be done at least once a year in individuals with T2DM. The first indication of kidney damage from diabetes is persistently increased urine protein level.

The most important things your grandmother can do to stall diabetic kidney disease are to: 

  • Make healthy lifestyle choices (by limiting the amount of salt she eats and losing weight if she is overweight)
  • Keep her blood sugar levels as close to normal as possible (through diet control, increased and regular physical activity and blood sugar lowering medications)
  • Keep her blood pressure below 140/90 mmHg (by limiting the amount of salt she eats and blood pressure lowering medications if needed) 
299 views 14 Jan 2019
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