World Kidney Day: The silent disease that shows the following symptoms

Are you living with diabetes? Then pause for a moment. It is not only your blood sugar levels that need monitoring but the health of your kidneys deserves equal care. Few people realise that diabetes is the leading cause of kidney damage and kidney failure worldwide. Often working silently, this condition can harm the kidneys long before any warning signs appear. Awareness and timely precautions remain our only defence against this hidden threat. Dr Rishi George, Senior Consultant of Internal Medicine and Diabetologist at Welmont Hospital, Kochi, explains.

Why does diabetes affect the kidneys?
The kidneys are among the most complex filtration units in the human body. Each kidney contains millions of tiny filters called nephrons. These microscopic structures remove waste products and excess fluid from the blood and expel them from the body through urine.

How does diabetes disrupt this process?
Excess pressure on the filters (Hyperfiltration): When blood sugar levels remain high, the kidneys work harder than normal. In the early stages, the kidneys try to cope with this extra workload. Over time, however, this continuous strain weakens the delicate filters within the kidneys.

Damage to blood vessels: Persistently high sugar levels can cause the blood vessels supplying the kidneys to stiffen and narrow. As blood flow decreases, the filters receive less oxygen and fewer nutrients, affecting their ability to function properly.

Leakage of protein: Normally, the kidney’s filters prevent proteins in the blood, especially albumin, from leaking out. But when diabetes damages these filters, protein begins to pass into the urine. This condition, known as microalbuminuria, is the earliest warning sign of kidney disease.

Scarring (Sclerosis): Over time, damaged filters develop scar-like changes around them. In medical terms, this is called glomerulosclerosis. Once such scarring occurs, the affected filters can no longer function properly, gradually reducing the kidneys' overall efficiency.

In short, high sugar levels slowly damage the kidneys like a sponge absorbing and weakening them from within. In the early stages, there may be no obvious symptoms, but inside the body, each nephron gradually loses its ability to function. That is why doctors repeatedly emphasise that controlling blood sugar is also a way of protecting your kidneys. A simple urine microalbumin test is enough to detect this condition early. Unfortunately, noticeable symptoms usually appear only after significant kidney damage has already occurred. This is why regular kidney check-ups at proper intervals are essential for people with diabetes.

When kidneys send quiet warnings
The greatest danger of kidney disease is that it often shows no symptoms in its early stages. That is why it is often called a `silent disease.' The condition may progress quietly within the body, and by the time noticeable symptoms appear, kidney function may already have declined by 40 to 50 per cent.

However, if you notice any of the following symptoms, it is important to consult a doctor without delay.
Swelling in the body (Edema): When the kidneys are unable to remove excess fluid from the body, it begins to accumulate in the tissues. Swelling is commonly seen in the legs, ankles and face, especially around the eyes in the morning. This may indicate that the kidneys are under stress.

Changes in urination: Waking up several times at night to urinate, a reduction in urine colour, or foamy urine may be warning signs. Foamy urine often indicates the presence of excess protein in the urine.
Extreme fatigue and weakness (Anaemia & Fatigue): When the kidneys do not function properly, they produce less of the hormone erythropoietin, which is essential for the production of red blood cells. This can lead to anaemia, causing persistent fatigue and weakness.

Persistent skin itching: If waste products and toxins are not effectively removed from the blood, they can accumulate and cause intense itching.
Loss of appetite and nausea: A buildup of waste substances, such as urea, in the blood (uremia) may cause loss of appetite and a metallic taste in the mouth.  This may eventually progress to nausea and vomiting.
Uncontrolled high blood pressure: If blood pressure remains high despite medication, kidney damage may be a possible underlying cause.

The most important advice for people with diabetes is not to wait for symptoms to appear. The only way to detect kidney disease early is through regular blood and urine tests conducted at proper intervals.

Key tests to protect your kidneys
Do not wait until symptoms develop. Make sure you undergo the following tests at least once a year:
Urine Microalbumin Test: This test helps detect whether excess protein is leaking into the urine, an early sign of kidney damage.
eGFR (Estimated Glomerular Filtration Rate): This blood test measures how efficiently the kidneys are filtering waste from the blood.

Five essential rules for healthy kidneys
1. Keep blood sugar under strict control: Maintain your HbA1c levels within the recommended range.
2. Manage blood pressure: Aim to keep your blood pressure below 130/80 mmHg.
3. Reduce salt intake: Lowering the amount of salt in your diet can help reduce stress on the kidneys.
4. Stay physically active: Engage in at least 30 minutes of brisk walking every day.
5. Be cautious with medications: Avoid taking painkillers without a doctor’s advice, as they can seriously harm the kidneys.

Kidney health is not just about numbers in medical reports; it forms the foundation of a healthy and fulfilling future. If you have diabetes, let this World Kidney Day be a reminder to take kidney health seriously. Do not wait for symptoms to appear. Get a Urine Microalbumin test and a Kidney Function Test (KFT) done at the earliest, and follow the lifestyle changes recommended by your doctor. Even a small precaution today can help prevent major health complications tomorrow.
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