Many people are diagnosed with diabetes when they develop one of its potentially life-threatening complications. If not controlled, diabetes can can affect nearly every organ in the body. One complication of diabetes is kidney damage. This is called nephropathy.

The kidneys are essential for filtering the blood from waste products. In diabetes, the elevated glucose levels damage the blood vessels that filter the blood. This leads to waste and fluid build-up in the blood, resulting in the kidneys failing to work properly.

Kidney damage begins long before any symptoms start to surface, however. An early sign is the presence of small amounts of protein in urine which indicate that the kidneys are being damaged.

Nevertheless, not everyone with diabetes develops kidney disease. Overall, kidney damage rarely occurs in the first 10 years of diabetes and usually 15 to 25 years will pass before kidney failure occurs. For people who live with diabetes for more than 25 years without any signs of kidney failure, the risk of ever developing it decreases. Factors that can influence kidney disease development include genetics, blood glucose control and blood pressure.

High blood pressure, or hypertension, is a major cause in the development of kidney problems in people with diabetes. It is defined as a sustained pressure of 140 mmHg over 90 mmHg or higher.

Family history of hypertension appears to increase chances of developing kidney disease. Hypertension also accelerates the progress of kidney disease when it is already present. Therefore, the more a person keeps diabetes and blood pressure under control, the lower the chances of getting kidney disease. It is recommended that diabetics regulate their blood pressure to below 130 mmHg over 80 mmHg.

Kidney failure results if kidney damage continues for a period of time. In fact, diabetes is the most common cause of kidney failure. People with kidney failure undergo either dialysis, an artificial blood-cleaning process, or transplantation to receive a healthy kidney from a donor. However, some of these detrimental effects can be counteracted by lifestyle changes such as exercising, quitting smoking, maintaining a healthy body weight and eating a varied and well balanced diet. In people who suffer from diabetes excessive consumption of protein may be harmful. Thereby, a low-protein diet can decrease protein loss in the urine and increase protein levels in the blood.

Significantly, although diabetes is a lifelong condition, it can be managed with proper treatment and care. The treatment depends on various factors such as the type of diabetes and is entirely individualised.

The first pharmacological treatment given in diabetes is metformin. This works by making increasing insulin sensitivity in the peripheral tissues and by promoting weight loss. People with diabetes should be screened regularly for kidney disease. The two key markers for kidney disease are estimated glomerular filtration rate (eGFR) and the presence of protein (albumin) in urine.

Furthermore, drugs used to lower blood pressure can slow the progression of kidney disease significantly. Two types of drugs, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), have proven effective in slowing the progression of kidney disease. It must be emphasised that while pharmaceutical intervention is available, lifestyle changes have greater efficacy and are practical and cost effective, making its implementation possible in any primary healthcare setting.

Long-standing positive behavioural adaptation and lifestyle modification will provide the answers to the fight against the impending epidemic of Type 2 diabetes mellitus and its detrimental effect on the kidneys.

Sign up to our free newsletters

Get the best updates straight to your inbox:
Please select at least one mailing list.

You can unsubscribe at any time by clicking the link in the footer of our emails. We use Mailchimp as our marketing platform. By subscribing, you acknowledge that your information will be transferred to Mailchimp for processing.