Diabetes Mellitus is known to be one of the leading causes of Chronic Kidney Disease worldwide. Continuous exposure to high glucose level has predisposed kidney to impending failure. Nevertheless, it is often being taken lightly by patients as the disease does not affect their health acutely. In most cases, patients would not realise that they suffer from Diabetic Kidney disease as it is often asymptomatic. They may appear normal, sitting on the bench waiting to be called for consultations or suffer from complications of multiple organs as the disease is systemic. If not treated, Diabetic Kidney Disease can lead to kidney failure that may be fatal.
With the advancement of the healthcare system, Diabetic Kidney Disease is currently being manifested through continuous monitoring of kidney function as it is mostly asymptomatic. Persistently elevated albumin excretion in urine and/or decrease eGFR are the most common clinical abnormalities that would suggest Diabetic Kidney Disease. The results should be persistently reproducible over a period of three to six months. This routine test is especially important to be introduced early in patients with Diabetes Mellitus type 2 as they are mostly diagnosed after many years of exposure to high sugar level. At a low level of albumin in urine, it can be reversed using medications such as ACE inhibitor initially, Hence, early detection and commencement of treatment are significant in preventing the development of Chronic Kidney Disease.
Diabetes affects our kidney in the spectrum. For example, Diabetic Nephropathy may develop if early detection is not done. A diabetic Nephropathy is a form of diabetic kidney disease diagnosed with markedly elevated albumin in urine beyond 3.5g per 24 hours. When this happens, patients may present with few symptoms which include repeated infections or Sepsis in a worst-case scenario as well as multiple episodes of blood clots affecting various organs. Since albumin has water retention ability, lack of albumin due to its excretion in urine may lead to swelling body parts thus causing patients to present with complaints of puffy face and rings can no longer fit on their fingers.
At a severe stage, patients may also present with symptoms suggesting of end-stage kidney disease. The patient may present in clinic with altered mental status such as feeling drowsy, personality change, unconscious or comatose. Some may also present with difficulty breathing, nausea, vomiting, itching and many more. Doctors would be horrified to see patient at this stage as urgent treatment such as dialysis may be required.
In a nutshell, symptoms of Diabetic Kidney disease may vary from one individual to another. It is mostly asymptomatic. If patients present with symptoms, this may indicate that their disease is heading towards the severe stage of diabetic kidney disease. With proper routine and periodic investigations, this disease may be reversed and prevented. Hence, it is crucial to emphasize adequate investigations for Chronic Kidney Disease.
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