Kidney Disease and Diabetes go hand in hand

• High protein levels in the urine and hypertension are among the harmful effects of diabetes on the kidneys 

Numerous diabetic patients suffer from diabetic nephropathy, which is a complication that is expected to occur over the years due to uncontrolled diabetes.  Diabetic nephropathy affects the kidneys’ ability to do their usual work of removing waste products and extra fluid from your body. Over time, the two diseases form a group of complications that affect all parts of the body. Over time, the high blood sugar levels damage the millions of tiny filtering units within each kidney. This eventually leads to kidney failure. 

Diabetic nephropathy takes many years before it develops and symptoms appear. It rarely occurs in the first ten years of diabetes onset. Symptoms begin about 15 to 20 years after the diagnosis of type 1 diabetes.

Why does sugar affect the kidneys?

Your kidneys contain millions of tiny blood vessel clusters that filter waste from your blood. Severe damage to these blood vessels can lead to diabetic nephropathy, decreased kidney function and kidney failure.

Damage to the kidneys puts stress on these vital organs and prevents them from working properly. When this happens, the body starts to lose protein through the urine, the kidneys cannot remove waste products from the blood and the kidneys cannot maintain healthy fluid levels in the body.

Patients with diabetes and microalbuminuria who progress to macroalbuminuria are more likely to progress to end–stage renal disease.

However, it is difficult to determine if a diabetic patient will develop diabetic nephropathy, but there are some risk factors that increase the risk of its occurrence, namely:

• Type 1 diabetes diagnosed before the age of 20 
• Uncontrolled diabetes, meaning that the patient suffers from high or low blood sugar levels
• Uncontrolled hypertension.
• Family history of diabetes and chronic kidney disease.

Diabetes harms the kidneys in several ways, including:

• Damage to the blood vessels inside the kidneys. Over time, high blood sugar levels can cause these blood vessels to get narrow and clogged. As your kidneys get less blood, less waste and fluid is taken out of your body.  When your kidneys are not working as well as they should, protein can leak through your kidney’s filters and into your urine.
• High blood sugar damages the nerves, and these nerves may stop sending messages to different parts of your body including the bladder. If the nerves of the bladder are damaged, the patient does not feel that it is full. This pressure on the bladder causes damage to the kidneys.
• If urine remains in the bladder for a long time, the patient can develop a urinary tract infection due to bacteria, especially as they grow rapidly in the urine with the high level of sugar. These infections often affect the bladder, but they may sometimes spread to the kidneys. 

Early signs and symptoms

The diabetic patient should do regular check-ups, especially in the case of type 1 diabetes. Having even a small amount of albumin in your urine (microalbuminuria) is a sign that early kidney damage is present. Research suggests that people with albumin in their urine are more at risk of eventually developing kidney or cardiovascular problems.

Early detection limits the development of the condition, but the delay in diagnosis and the lack of appropriate treatment leads to an increased excretion of urinary albumin. Macroalbuminuria of clinical nephropathy is when albumin excretion in a 24-hour urinary collection is greater than 300 mg continuously; this is called nephrotic syndrome.

When should we perform a urine microalbumin test?

Screening for microalbuminuria should be initiated five years after diagnosis of type 1 diabetes and at diagnosis of type 2 diabetes. The test should be repeated annually. During the microalbumin test, you simply need to provide a fresh urine sample. Your doctor may ask you to collect all of your urine in a special container over a 24-hour period and submit it for analysis.

Your doctor may ask you to provide a urine sample first thing in the morning or after a four-hour period of not urinating. A random urine test can be taken at any time. But to improve accuracy of the results, it’s often combined with a urine test for creatinine — a waste product usually filtered by the kidneys.

Managing diabetes means managing blood glucose, blood pressure, and cholesterol. The patient should follow a healthy diet, exercise regularly while taking the right medications to help control his blood sugar levels.

Patients should also control their glucose levels and take measures to lower blood pressure such as losing weight, reducing salt intake, quitting smoking, and increasing activity levels. 

Treatment

The most important steps of treatment and complication prevention include good control of blood sugar levels, undergoing regular check-ups, especially urine microalbumin test because it indicates the presence of changes in the blood vessels that filter blood and eliminate waste.

Angiotensin–converting enzyme (AEC) inhibitors are a type of medications that lower the blood pressure. ACE inhibitors prevent an enzyme in the body from producing angiotensin II, a substance that narrows blood vessels. This narrowing can cause high blood pressure and forces the heart to work harder. Angiotensin II also releases hormones that raise blood pressure.

Reducing salt intake is an important step in the nutritional program developed by a nutritionist and adopted by the patient due to the damage it causes to the kidneys, in addition to limiting the consumption of animal protein such as meat and others. 

What is the diet of a patient with diabetic nephropathy?

An appropriate diet and drug treatment have an effective role in maintaining kidney health and controlling blood sugar level. Therapeutic nutrition for these patients aims to maintain glucose levels and improve lipid levels, as well as reduce blood pressure and complications of diabetes, including heart, eye, nerve, and kidney diseases.

A low-protein diet should be followed as it puts less strain on the kidneys. As a result, this type of diet can benefit people with kidney-related disorders such as kidney disease. A low-protein diet can reduce the loss of protein through the urine and increase protein levels in the blood. The patient should also reduce or stop his salt intake and the doctor may ask him to stay away from citrus fruits, sweets, and various baked goods. Both sugary and starchy carbohydrates can raise blood sugar levels. In addition, a diet with more fruits and vegetables and less or no animal protein may lower acid in the body to promote kidney health.

Prevention is the most effective way to protect the kidneys from diabetic disorders, and the most important step is to maintain normal blood sugar levels by following a healthy diet, exercising regularly and taking the medications as prescribed by the treating physician.

Foods to avoid if you have diabetic nephropathy

• Processed meats that are made by drying, salting, curing, or smoking meats which eliminate all nutrients.
• Sodas, especially dark-colored varieties, as they contain 90–180 mg of phosphorus per 355-mL serving. Healthy kidneys can easily remove excess phosphorus from the blood, but this isn’t the case when you have kidney disease.
• Fruit juices and other sugar-sweetened beverages because they contain many preservatives and added sugar that can cause rapid spikes in blood sugar.
• High potassium fruits such as bananas, avocados, apricots, kiwis and oranges. Fortunately, there are plenty of healthy low potassium fruits you can add to your diet in moderation as long as you monitor your carb intake. Grapes, berries, pineapple, mango, and apples are a few examples.
• Processed foods as they are high in sodium which actually alone makes up 60-70% of the daily sodium allowance. 
• Dried fruits aren’t ideal for people with kidney disease and diabetes because they’re high in sugar and minerals like potassium.
• For people with kidney disease and diabetes, beans and lentils are not ideal due to their relatively high phosphorus content. Canned versions are typically also high in sodium.
• Various leafy green vegetables, such as spinach, chard and beet greens, because they contain high amounts of nutrients like potassium.