It is now well documented that diabetes mellitus affects all organs of the body- the eyes, kidneys, feet etc. Kidney problem caused by diabetes is termed as Diabetic nephropathy.
Kidneys are important excretory organs. They are a pair – situated at the back of the abdomen, below the diaphragm, one on each side of the spinal column. Kidney disorders are serious and life threatening. Renal failure means mal functioning or incapacity of the kidneys to perform their function and is a dreaded word. Treating kidney disorders is generally costly.
The main function of the kidneys is to filter impurities from the blood. The impurities are excreted through urine.
Each kidney looks like a bean and about 4 to 5 inches long. Blood supply to the kidney is through renal arteries, branches of Aorta. From renal arteries blood flows through smaller arterioles in to capillaries of the glomeruli. Eack kidney contains about one million nephrons. Nephrons are tiny, microscopic, active units of the kidney that filter the blood, under pressure and produce urine. Each nephron contains a glomerulus (plural: glomeruli) swrrounded by the bowl – shaped Bowman’s capsule (cup like and). These, besides other tubules, help in collecting & draining the urine. The urine drains from the collection ducts of thousands of nephrons into a cuplike structure called calix. From calix, urine drains into the central chamber (renal pelvis) from where it goes into Ureter. Ureter is one of the pair of tubes, 25 to 30 cm long which moves the urine to the bladder.
The good thing about kidneys is that one kidney is enough to carry out the functions normally carried out by 2 kidneys. There are of course, cases of persons, born with only one kidney.
Through urine, kidneys eliminate metabolic waste products like excess water and electrolytes. Kidneys also help in regulating body’s blood pressure through the enzyme renin. Similarly kidneys help in production of red blood cells through a hormone (erythropoietin)
Diabetis is one of the most common causes of kidney damage. About 30% of diabetic patients get afflicted with diabetic nephrology. Some put this figure to 30% among type 1 patients and 10% among type 2 diabetes.
In normal persons, kidneys, through glomeruli, retains proteins in the body. Diabetes damages the kidneys, causing leaking out of protein (albumin) in to the urine. Kidney’s filter system gets damaged and the waste product pile up in the blood stream.
Albumin is a protein synthesised in the liver. Due to diabetes caused kidney disease called micro lbuminuria, serum albumin, serum globulin and other protein show up in the urine. Micro buminuria a is also called proteinuria. Also creatinine (derived from creatine, a product of protein metabolism) is excreated through urine. An excessive presence of creatinine in the urine indicates the disorder creatinuria.
Urea is the chemical form in which unreguired nitrogen is excreted by the body in the urine. In kidney failure, urea along with other nitrogenous compounds get accumulated in the blood stream and gives rise to uraemia.
Until the diabetic nephropathy is advanced, the patients do not show any symptom. But these days, once diabetes is detected, periodic check up of urine, help in preventing or halting the progress of nephropathy.
How to prevent / control diabetic nephropathy
1. Testing the urine for micro – Albuminuria a, every 6 months in a must for diabetic patients. The blood also should be tested for amounts of creatinine and urea. Carry out other kidney tests suggested by your doctor.
2. Control your blood sugar level and keep it normal.
3. Take care of your blood pressure. Keep it at 130/85.
4. The diet regimen and life style you maintain to control diabetes may be revierved periodically with your doctor.
5. Do not neglect urinary infections. Burning sensation which passing urine, urinary incontience, cloudy or red coloured urine etc, are symptoms that should be informed to the doctor treating you.
The normal levels of creatinine etc in the urine are given below.
1. Creatinine – 1 to 1.5 gm.
2. Urea – 10 to 40 gm.
3. Uric acid – 0.5 to 0.8 gm.
4. Allumin – NIL
5. Protein – NIL.
Blood
1. Urea – 12 to 40 mg per 100 ml
2. Serum total protein – 6 to 7.5 gm per 100 ml.
3. Serum Albumin – 4 to 5 gm 100 ml.
4. Serum Uric acid – 2 to 5 gm per 100 ml.
The above figures are just indicative. Consult your doctor for keeping your blood sugar under control and monitor your kidneys with periodic check ups.
Kidney Problems in Diabetes
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