As mentioned in the first part of this article series, diabetes has the potential to cause multiple complications in the long term, if high glucose levels are sustained chronically (hyperglycemia). These complications include macro and microvascular (in large and small blood vessels, respectively). Among the microvascular complications, there is damage to the blood vessels of the kidneys (nephropathy), nerves (neuropathy) and eyes (retinopathy). These are the most affected due to their blood vessels being the smallest in the human body.
Kidneys have a series of small blood vessels through which blood arrives to be filtered. Afterwards, these waste products are contained in the bladder to be eliminated in the urine. Diabetic nephropathy refers to the damage of the blood vessels that arrive to the kidneys, due to poor diabetes control. Chronic hyperglycemia increases blood flow to the kidneys for filtration. This provokes cellular injuries to the kidney. The more time glucose is high due to poor diabetes control, the more damage will be present. Thus, kidneys’ capacity to filter blood is progressively lost and kidney failure occurs, known as chronic kidney disease (CKD).
The risk of developing kidney damage is always latent, and detection is complicated because there are no symptoms until the capacity to filter blood is very low. However, early diagnosis is possible as small quantities of protein are lost in the urine, known as microalbuminuria. A urine test allows detecting abnormal levels of proteins in the urine, making this an opportunity to prevent damage progression by improving glucose control. Therefore, regular medical appointments with further tests are important, in order to detect a possible damage and delay its progression.
In contrast, if kidney damage is not diagnosed in time, filtration capacity of the kidneys will be progressively reduced. This would occur to the point that these are not capable of fulfilling their function, leading to CKD on a terminal stage (end stage renal disease). On this case, replacing kidney function is essential, and the patient must undergo a kidney transplant or a procedure that artificially allows waste products to be removed from the body, also known as dialysis. It includes hemodialysis and peritoneal dialysis. Hemodialysis lasts 3 to 5 hours and must be performed 2 to 3 days per week, in order to filter the blood through an artificial kidney outside the body. As for the peritoneal dialysis, a layer that covers the organs (peritoneum) serves as a filter when a fluid is injected on the abdomen and waste products are later extracted. This can be done several times a day or during the night. These treatments are exhausting for the patient, besides requiring a stricter pharmacological control and a drastic diet change.
In order to avoid diabetes progression to CKD, a medical evaluation of the kidneys and any possible damage is recommended when type 2 diabetes is diagnosed. It is worth mentioning that the incidence of end stage renal disease (terminal) is ten times higher in people with diabetes. Besides, health cost nearly triples when dialysis is performed.
The Mexican National Academy of Medicine recommends an annual screening for microalbuminuria test in people with diabetes. However, only 14.2% of Mexicans with diabetes undergo a urine test annually.
Early detection of kidney damage improves the quality of life in people with diabetes. If you or any of your friends have diabetes, we invite you to attend regular medical checkups to prevent these complications, as well as to maintain good blood glucose control to prevent its onset.
Academia Nacional de Medicina. Acciones para enfrentar la diabetes. 2015. Available from: https://www.anmm.org.mx/publicaciones/CAnivANM150/L15-Acciones-para-enfrentar-a-la-diabetes.pdf
American Diabetes Association. Living with diabetes: Complications. Available from: http://www.diabetes.org/living-with-diabetes/complications/?loc=lwd-slabnav
Federación Internacional de Diabetes. Diabetes Atlas de la FID. International Diabetes Federation 2017. 8va Ed.
Instituto Nacional de Estadística y Geografía. Principales causas de mortalidad por residencia habitual, grupos de edad y sexo del fallecido. Consulta de resultados: Tabulados básicos.
Secretaría de Gobernación. Norma Oficial Mexicana NOM-015-SSA2-2010. Para la prevención, tratamiento y control de la diabetes mellitus. Diario Oficial de la Federación. 2010. Available from: http://www.dof.gob.mx/nota_detalle.php?codigo=5168074&fecha=23/11/2010
Secretaría de Salud. Encuesta Nacional de Salud y Nutrición de Medio Camino 2016: Informe final de resultados. 2016. Instituto Nacional de Salud Pública.