Diabetic Kidney Disease / Diabetic Nephropathy

What is Diabetic Kidney Disease?

Diabetic kidney disease (DKD), also known as diabetic nephropathy, is a common long term complication of both type 1 and type 2 diabetes.It occurs when the high blood sugars damages the blood vessels of the kidney. Not everyone with diabetes is affected by nephropathy.

Diabetic Mellitus (DM) or simply, diabetes, is a common metabolic disease that affects a large population across the world. In the United States, diabetes is the most common cause of kidney failure and accounts for over one-third of all dialysis patients. India is now deemed the world’s capital of Diabetes and diabetes along with hypertension accounts for over 50% of kidney failure.

Diabetic impairs the function of many organs such as the heart, kidneys, nerves, blood vessels and eyes as it affects the micro-circulation of these vital organs. It can lead to various complications like heart disease, stroke, peripheral arterial disease, retinopathy (blindness), kidney disease or nephropathy, nerve problem in the limbs or peripheral neuropathy and lower extremity amputations. Other complications include reduced immunity leading to increased risk of infections like pneumonia.

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In diabetes there is deposition in certain layer of smaller arteries and capillaries of a plaque that impairs the circulation. It also leads to calcification of the larger arteries.

Diabetes is the most common cause of amputation of toes and feet due to peripheral vascular disease of the lower limbs. The other common problem is of blindness due to retinal damage-from micro-angiopathy.

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Types of Diabetes

Type-I Diabetes occurs when the pancreas secretes very little, or no, insulin and the patient has to be given shots of the hormone for survival. This condition is known as Insulin-Dependent Diabetes Mellitus or IDDM - I. Type 1 diabetes accounts for 5-10% of all cases of diabetes.

The onset of IDDM I is abrupt and occurs early in life; it commonly occurs among children and young adults. Hence it is also known as juvenile onset diabetes.

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In the case of Type-2 diabetes, non-insulin-dependent diabetes, or NIDDM II, the problem occurs due to peripheral resistance to insulin. It usually occurs in susceptible individuals above the age of 40 years. Nearly 90-95% percent of all diagnosed diabetes cases are due to Type-2 diabetes.

Other minor forms of diabetes are Gestational diabetes that affects some women during pregnancy and diabetes caused by genetic defects.

The best way to diagnose diabetes related kidney damageis through a simple urine test which can detect traces of protein (albumin). An additional blood test (serum creatinine) may also be carried out to evaluate kidney function.

Deterioration of kidney function can lead to a build- up of toxic substances and fluids which in turn can lead to kidney damage. It is important to start treatment early, as continued damage can lead to kidney failure. Incidentally, kidney damage is one of the foremost reasons for kidney failure. Once kidneys have failed the only method of management is a dialysis or a kidney transplant. It is possible to minimize kidney damage and to prevent it from worsening through medications, lifestyle modifications and insulin shots according to patients requirements.