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Can Diabetes Cause Kidney Disease?

Can Diabetes Cause Kidney Disease

Anthony, a 58-year-old man, who generally leads a sedentary lifestyle spending most of his day in front of a computer, recently experienced facial and bilateral lower limb swelling. Concerned about his symptoms, he sought medical attention at the nephrology department of a hospital. Upon thorough examination and inquiry into his medical history, the doctor learned that Anthony has been living with diabetes for over 20 years. He has been taking antidiabetic medications but has not been actively monitoring his blood sugar levels or adhering to a controlled diet, leading to poor blood sugar control. Additionally, his blood pressure has gradually increased over the past two years.

The results of a urine test revealed a significant proteinuria of up to 2.0 grams in a 24-hour collection (normal is less than 0.15 grams). An examination of his retinas identified signs of diabetic retinopathy, and there were indications of declining kidney function. The doctor diagnosed Anthony with diabetic nephropathy, a condition where diabetes causes damage to the kidneys.

Why Does Diabetes Cause Kidney Damage?

Diabetes is a chronic metabolic disorder characterized by elevated blood sugar levels. It is well-known that managing blood sugar is crucial, as persistent high levels of glucose can cause chronic damage to organs throughout the body, creating a “sweet burden.” Among the complications associated with diabetes, kidney damage is particularly representative.

Diabetic nephropathy refers to kidney damage caused by diabetes itself. The main clinical sign is the presence of persistent proteinuria, specifically continuous albuminuria exceeding 200 micrograms per minute or 300 milligrams per 24 hours. Typically, diabetic retinopathy is also present. The damage to the kidneys in diabetes is primarily due to the impact of high blood sugar on the glomeruli (tiny blood vessels) and renal blood vessels.

The human kidneys have approximately one million glomeruli, and long-term high blood sugar can gradually lead to sclerosis of these glomeruli. High blood sugar also damages the renal arteries, and prolonged exposure can result in the hardening and even narrowing of these arteries, leading to a decline in kidney function.

Diabetic nephropathy is a chronic process. Early clinical symptoms are often subtle and may include microalbuminuria (urinary albumin excretion rate between 20 and 200 micrograms per minute or 30 and 300 milligrams per hour). In the clinical nephropathy stage, urinary albumin excretion rate exceeds 200 micrograms per minute or 300 milligrams per 24 hours, or the total urinary protein exceeds 0.5 grams per 24 hours. Approximately 10% of individuals with diabetic nephropathy clinically manifest as nephrotic syndrome, with a urinary protein excretion rate exceeding 3.5 grams per 24 hours, reduced serum albumin, and potential edema.

kidney disease

In patients with diabetes, approximately 20% to 40% may develop diabetic nephropathy. The incidence of kidney disease in individuals with type 1 diabetes is related to the duration of diabetes, with a rate of 40% to 50% after 20 to 25 years of the disease. For those with type 2 diabetes, the incidence of diabetic nephropathy is around 20% to 50%. If it progresses to the later stages of renal failure, symptoms of uremia gradually appear. Diabetic nephropathy is a significant cause of disability and mortality in individuals with diabetes. In developed countries in Europe and America, the proportion of diabetic patients among dialysis patients has long surpassed that of nephritis.

The high prevalence and significant impact of chronic complications in diabetes necessitate a strong emphasis on prevention and treatment, particularly focusing on early prevention and comprehensive management. Early prevention is crucial. Diabetic patients should undergo regular urine tests, including checking urinary protein excretion rates.

Especially for those with a diabetes history of more than 5 years, monitoring should occur at least twice a year. Controlling blood sugar effectively is a fundamental measure in preventing and delaying various chronic complications of diabetes. Blood glucose levels must be well-controlled, with fasting blood sugar levels below 140 mg/dL (7.8 mmol/L), postprandial 2-hour blood sugar levels below 180 mg/dL (10.08 mmol/L), and glycated hemoglobin levels below 7.0%. For some patients, achieving even lower levels, such as fasting blood sugar below 110 mg/dL (6.1 mmol/L), postprandial 2-hour blood sugar below 140 mg/dL (7.8 mmol/L), and glycated hemoglobin below 6.5%, is more desirable.

Diabetic Kidney Disease Symptoms

In the early stages of diabetic nephropathy, it’s unlikely to notice any signs or symptoms. Late-stage signs and symptoms may include:

Deterioration of blood pressure control

Presence of protein in the urine

Swelling in the feet, ankles, hands, or eyes

Increased frequency of urination

Reduced need for insulin or diabetes medications

Confusion or difficulty concentrating

Shortness of breath

Loss of appetite

Nausea and vomiting

Persistent itching


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Can Diabetic Kidney Disease Be Cured?

Once diabetic nephropathy occurs, adherence to medical advice and active treatment is essential. Rigorous self-monitoring and management of blood pressure, blood lipids, and blood sugar are crucial to maximize the delay of kidney disease progression. Specific measures include the following:

Control Blood Sugar: Good blood sugar control can reduce the risk of developing diabetic nephropathy by half in type 1 diabetes patients and by one-third in type 2 diabetes patients. If diet and oral hypoglycemic medications are not effectively controlling blood sugar, adjustments to medication should be made promptly according to medical advice. As a patient, regularly monitoring blood sugar levels and providing timely feedback to the treating physician for medication adjustments is crucial.

Control Blood Pressure: Hypertension is a significant factor in exacerbating diabetic nephropathy. Diabetic patients should maintain a low-salt diet, strictly limiting salt intake to no more than 6g (equivalent to one beer bottle cap). Those with accompanying hypertension must use antihypertensive drugs for treatment, rigorously controlling blood pressure within the normal range, preferably below 130/80 mmHg, or maintaining blood pressure at an appropriate level based on the doctor’s recommendations.

Diet Control: A low-protein diet, preferably with high-quality animal proteins, can slow down kidney damage in diabetic patients. The standard for a low-protein diet in diabetic patients is 0.6-0.8g of protein per kilogram of body weight per day, while ensuring an adequate calorie intake. However, patients with liver disease, those in pregnancy, or individuals in periods of growth and development should be cautious not to excessively restrict protein intake.

Lipid Control: Elevated lipid levels have extremely adverse effects on diabetic nephropathy, especially when combined with cardiovascular complications. If high lipid levels are detected, lipid-lowering medications should be taken under medical guidance to correct the imbalance.

Maintain Healthy Lifestyle Habits: Proper weight control, moderate exercise, smoking cessation, and limiting alcohol intake contribute to a healthy lifestyle.

Renal Replacement Therapy: Having diabetic nephropathy, even if it reaches end-stage renal disease, is not the end of the world. Renal replacement therapy, including hemodialysis, peritoneal dialysis, and transplantation, is the most successful among all organ replacement therapies. Even in cases of renal failure, these treatments provide viable options.

Dietary Taboos for Diabetic Kidney Disease

How to Prevent Diabetic Kidney Disease?

Diabetic nephropathy in its early stages is primarily characterized by microalbuminuria, with an increase in foam in the urine. If blood glucose is not effectively controlled over an extended period, it can progress to sustained macroalbuminuria. Further progression may lead to a gradual decline in kidney function, ultimately culminating in end-stage renal failure (uremia), requiring dialysis or kidney transplantation for maintaining normal life. Therefore, early identification and standardized treatment are crucial. Common preventive measures for diabetic nephropathy include:

Regular Assessments: Individuals with a diabetes duration exceeding 5 years should undergo regular assessments every 3-6 months, including kidney function tests, qualitative proteinuria analysis, 24-hour urine protein quantification, glycated hemoglobin (HbA1c) monitoring, and blood pressure checks. Additionally, an annual eye examination is recommended.

Monitoring Urinary Protein: When feasible, perform urinary albumin testing. If there is an increase in microalbuminuria, conduct the test two more times within a 3-6 month period to confirm whether it is persistent microalbuminuria.

Strict Control of Blood Glucose, Blood Pressure, and Lipids: If microalbuminuria is confirmed, and other factors causing its increase, such as urinary tract infections, exercise, or primary hypertension, are ruled out, strict control of blood glucose is crucial. If blood pressure is above 140/90 mmHg and lipid levels are elevated, active measures should be taken to lower blood pressure and lipids, maintaining them within normal ranges. Additionally, adopting a low-salt, low-fat, low-protein diet with a focus on consuming high-quality animal protein is advisable.

Regular Exercise: Maintaining a healthy weight is important to reduce the burden on the kidneys and prevent damage. Patients are recommended to engage in moderate-intensity aerobic exercise for over 150 minutes per week, such as exercising for 5 days a week, 30 minutes per day. Additionally, incorporating resistance training, like dumbbell exercises, push-ups, and planks, for at least two to three days a week is beneficial.

Monitor Medications Impact on Kidneys: Some commonly used medications, including analgesics, gastric medications, contrast agents, and certain herbal remedies, may cause varying degrees of kidney damage. Traditional Chinese medicine may have concepts related to “kidney tonification,” but it’s crucial to differentiate this from the anatomical kidneys. It’s important to avoid self-prescribing medications, including herbal remedies, to prevent inadvertent kidney damage. When using medication, including traditional Chinese medicine, consult with a qualified healthcare professional to obtain a prescription. Avoid relying on unverified remedies and diets for long-term health, as these can pose risks of kidney damage.

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