10 Things about Diabetes and Kidney Disease

In Singapore, diabetic kidney disease, also known as diabetic nephropathy, remains the number one cause of kidney failure. A significant number of these patients could have had their kidney failure prevented or delayed had there been a good control of sugars.

Kidney function and health is directly linked to blood sugars. In many cultures such as Malay and Tamil, the respective terms for diabetes namely “kencing manis” and “inippu neer” mean sugar in the urine or “sweet urine”.

Because there is a suboptimal understanding and awareness of kidney disease, I will structure this article as “Ten things that I want everyone to know”.

  • Kidney damage, in most cases, is a painless process. Many patients who find out that they suffer from kidney disease are shocked to find out. “But doctor, I have no pain” is the common response. The mechanism by which the kidney is damaged in diabetes does not elicit an inflammatory response which causes pain. Moreover, the kidney organ, save for select areas is poor in nerve fibers that carry pain. So, unless the capsule is involved or there is an increase in pressure in the kidneys, there is no pain.
  • The commonest symptom of kidney damage is “no symptoms”. Most patients with kidney disease, till the very advanced stages, do not have any symptoms at all. Please do not wait for symptoms to be tested for kidney disease.
  • Kidney disease is preventable in most cases. It is not inevitable that patients with diabetes will end up with kidney failure. This is a popular misconception. There are many things you can do along with your doctor’s inputs to help prevent or delay the onset of kidney failure.
  • All diabetic patients and those with other risk factors for kidney disease need to be tested for kidney damage. For the above listed reasons, it is recommended that all patients with diabetes need to get urine and blood tests to screen for kidney disease on a regular basis.
  • There is effective management of kidney disease in all stages, but there is no known cure to diabetic kidney disease. It is true that there is no way to reverse damage that has already occurred. But, at all stages of kidney disease, care can be optimized to improve outcomes for the patients.
  • Kidney function decline is a lag indicator and there are specific tests that detect kidney damage even before decline in kidney function. The detection of traces of a protein called albumin precede kidney function decline. It is possible to detect kidney damage earlier in order to intervene more effectively and protect your kidneys.
  • There are specific diabetes medications that may be helpful to protect your kidney. Do talk to your doctor if those are appropriate for you. So, not all diabetes medications are created equal. Some diabetes medications protect kidneys by mechanisms that are independent of their sugar lowering effects.
  • There are specific medications in the class of “Blood pressure medications” that can help protect your kidneys. Not all blood pressure medications are created equal. There are BP lowering medications that can help protect your kidneys independent of their BP lowering effects.
  • It is never too late to make positive changes towards improving your kidney health and/or your overall health. Even in someone with late stage kidney diseases, there are steps that can be taken to improve the wellness and sense of well-being for the patients.
  • Just because a medication is “Over the Counter” or of herbal origin, that does not necessarily make it safe for your kidney. Please do not self-medicate. Educate yourself. Talk to your doctor about both prescribed and over the counter medications you consume. Also about any alternative systems of medicine you subject yourself to such as TCM, Jamu or Ayurveda treatments.

Most of all, look after your kidneys. They need to last you for your lifetime. A kidney specialist like myself can be a valuable ally and a guide to walk the journey of kidney health and kidney disease by your side.

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Written by: Dr Srinivas Subramanian, renal medicine and internal medicine specialist practising in Parkway East Hospital, Singapore.