Kidney disease and diabetes

One of the possible complications of diabetes is diabetic kidney disease or diabetic nephropathy. Although the majority of people with diabetes do not suffer alterations in the function of the kidneys, it is a known fact that diabetes is the most frequent cause of renal failure. According to the Best Kidney Specialist in Delhi, in India it constitutes about 25% of new cases who need renal replacement therapy by dialysis or transplantation. For this reason, knowledge of the course of the disease and the application of preventive measures is essential.

Diabetic kidney disease (diabetic nephropathy) takes years to develop. In some diabetics over the years small amounts of albumin (a protein in the blood) begin to pass into the urine. This first stage of renal involvement is known as microalbuminuria. During this period the filtering functions of the kidney usually remain normal. As the disease progresses, more albumin passes into the urine. This stage can be called microalbuminuria or proteinuria. As time goes by and while the amount of albumin in the urine increases, the filtering functions of the kidneys usually deteriorate, and some substances such as urea and creatinine rise in the blood due to lack of elimination in the urine. As kidney damage progresses, blood pressure often increases as well.

In people who develop kidney disease, damage rarely occurs during the first 10 years of diabetes, and it usually takes between 15 and 25 years before kidney failure occurs. People who have had diabetes for more than 25 years without showing any signs of kidney failure have a lower risk of developing it, says Kidney Specialist in Delhi.

Prevention and delay of the course of kidney disease

In the same way that other complications related to diabetes are prevented, a strict control of glucose is the main factor to prevent the onset of diabetic nephropathy, says nephrologist in Delhi. It is what is called primary prevention. Once the kidney injury is established, secondary prevention is aimed at the control of arterial hypertension, especially with drugs that block the so-called renin-angiotensin-aldosterone system, to the dietary advice with a decrease in the amount of proteins to “reduce the workload to the kidneys”, which together with the Glucidal control are essential elements to stop or delay the progression of kidney disease. The best results are achieved when this secondary prevention is established very early in the microalbuminuria phase.

The patient with diabetes with advanced kidney disease

According to top nephrologist in Delhi, multidisciplinary care is key in the care of these patients. Primary Care Medicine, Endocrinology and Nephrology must act in combination for the establishment of preventive measures and the care of patients with diabetic nephropathy. When kidney disease has developed, the follow-up in a Nephrology clinic, and more specifically in a clinic for Chronic Advanced Kidney Disease (ACKD), time before the start of renal replacement therapy, has shown multiple advantages compared to patients who are submitted late.

In the consultation, best nephrologist in Delhi focuses on diet, lifestyle habits and adherence to treatment. Alterations characteristic of kidney disease such as anaemia, or disorders of bone metabolism, among others, are also treated. A fundamental aspect of the consultation is that with sufficient time information is given on the modalities of renal replacement therapy, so that the patient and his family choose the technique that best suits their preferences and way of life. These are kidney transplantation and dialysis with its two variants, peritoneal dialysis and haemodialysis.

Can a transplant be done before starting dialysis?

Kidney transplant in Delhi is, without a doubt, the treatment of choice in cases of advanced renal failure when this is possible. The transplantation of a kidney from a living donor offers undoubted advantages; the organ that is going to be transplanted is “the best possible” since the donor has been studied meticulously from the clinical point of view and will be discarded before the slightest problem. On the other hand, the surgical procedure, elective and programmed, avoids all suffering of the organ to be transplanted, which improves the results. With a relatively low risk for the donor, dialysis is avoided with the consequent positive impact that this entails both in terms of morbidity and complications, and from the point of view of psychological adaptation to the disease, family and social relationships.

For these reasons, from the nephrologist in Delhi consultation, and therefore, before the start of dialysis, the possibility of an anticipated live donor kidney transplant should be explored.