How diabetes destroys the kidneys
Constantly elevated glucose levels damage the smallest vessels of the glomeruli - the very filters through which blood passes. The wall of the glomerulus thickens and at the same time becomes more permeable, and the pressure inside it increases.
First, albumin, a protein that should not be in the urine, begins to leak through the damaged filter. Then the glomeruli gradually become sclerotic and stop working, and the load on the remaining ones increases, which accelerates their death.
That is why the appearance of even a small amount of albumin in the urine is not a trifle, but the earliest alarm signal, at which it is still possible to intervene and change the course of events.
Stages and what happens at each
- Early stage - filtration is even increased, there are no changes in the analyzes; no complaints
- Microalbuminuria - a small amount of albumin in the urine; the key moment to start treatment, when the changes are still largely reversible
- Proteinuria - significant loss of protein, edema appears, blood pressure rises, GFR begins to decrease
- Decreased kidney function - increase in creatinine, anemia, disturbances of phosphorus-calcium metabolism
- End stage - need for dialysis or transplantation
Symptoms when they appear
- Swelling on the legs, later on the face
- Increased blood pressure, increasingly difficult to treat
- Foamy urine due to protein
- Night urination
- Fatigue, weakness, decreased performance
- Decreased appetite, nausea
- Itchy skin
- Paleness due to anemia
- Paradoxical decrease in the need for insulin - the kidneys stop destroying it, and sugar levels drop more often
This last point is important and often misinterpreted: if a person with long-term diabetes suddenly finds it easier to retain sugar and hypoglycemia becomes more frequent without changing therapy, this may be a sign of decreased kidney function, rather than an improvement in diabetes.
Who should check their kidneys and how often?
- For type 2 diabetes - immediately upon diagnosis, then annually
- For type 1 diabetes - five years from the onset of the disease, then annually
- Minimum set: albumin/creatinine ratio in a single urine sample, blood creatinine with GFR calculation, general urine test
- Additionally: blood pressure measurement, glycated hemoglobin, lipid profile
- Ultrasound of the kidneys and bladder with determination of residual urine - especially with a long history of diabetes
- If albuminuria is detected, the analysis is repeated to exclude an accidental increase.
What Really Slows Progression
- Strict control of glucose and glycated hemoglobin levels
- Strict blood pressure control is as important as sugar control
- Drugs that reduce protein loss in urine and protect the kidneys - prescribed by a doctor
- Modern hypoglycemic drugs with a proven nephroprotective effect - selected by an endocrinologist
- Limiting salt
- Moderate protein restriction in later stages as recommended by a doctor
- Quitting smoking - smoking accelerates progression significantly
- Weight loss and regular physical activity
- Lipid profile correction
- Avoidance of non-steroidal anti-inflammatory drugs without prescription
- Be careful with contrast studies—warn your doctor about diabetes and creatinine levels
Urological problems that accelerate kidney damage
In diabetes, the kidneys suffer not only from damage to the glomeruli. There is a second line of threat - urological, and it is often overlooked.
- Diabetic neuropathy of the bladder: the bladder loses sensitivity, becomes overfilled, and a large volume of residual urine remains
- Chronic urinary retention with increased blood pressure and kidney damage
- Frequent and severe urinary tract infections
- Asymptomatic bacteriuria, which in patients with diabetes often develops into pyelonephritis
- Purulent complications: kidney abscess and carbuncle, emphysematous pyelonephritis
- Prostate adenoma is more severe in men with diabetes
- Urolithiasis
That is why it makes sense for a patient with a long history of diabetes to undergo an ultrasound of the bladder at least once to determine residual urine: painless urinary retention due to neuropathy does not give any sensations, but imperceptibly destroys the kidneys.
Where to get examined in Tashkent
Management of diabetic nephropathy is a joint effort between the endocrinologist and the nephrologist, and the urologist is responsible for identifying and treating mechanical causes of deterioration: residual urine, prostate adenoma, stones, and infections.
In Tashkent, urological examination of patients with diabetes, including ultrasound with determination of residual urine and prostate assessment, is carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
If you have diabetes and have never had a urine test for albumin, start with that. This is a simple and inexpensive test that detects problems years before complaints arise. Clinic contacts are below.
