November 14th is United Nations Diabetes Day
For a long time, the public's understanding of diabetes has mainly been limited to "harming blood sugar and eyes", often neglecting that it can also cause severe and even irreversible damage to the kidneys.
Diabetic nephropathy is insidious in onset and can be called a "silent killer". Early screening and intervention are crucial to seize the "golden reversal period". For patients with diabetes complicated by nephropathy, daily management not only involves controlling blood sugar but also protecting the kidneys.
Chen Wen, Director of the Nephrology Department at Hainan Chengmei Hospital, and Hou Zeling, Attending Physician of the Endocrinology Department, respectively explained the key points of kidney care for diabetic patients from the perspectives of screening and early warning, as well as home management.
Key point: Damage to the "filter": How does long-term high sugar intake harm the kidneys?
"Many people don't understand why diabetes can also damage the kidneys," explained Director Chen Wen. Diabetic nephropathy is a kidney disease caused by long-term high blood sugar levels slowly damaging the tiny blood vessels in the kidneys. It is a very common microvascular complication of diabetes and a major cause of uremia.
(Director Chen Wen is holding outpatient clinic hours)
Director Chen Wen vividly likened the kidney to a "filter", stating that long-term high sugar intake will gradually damage this filter. In the early stages, the filter becomes more permeable, leaking a small amount of albumin, and most patients do not feel uncomfortable. However, if not detected and properly managed in a timely manner, the damage to the filter will become more severe, leading to a significant leakage of protein. This will gradually decrease kidney function, eventually progressing to chronic kidney failure, and may even require dialysis to sustain life.
Regarding the local situation in Hainan, Director Chen Wen pointed out that the prevalence of diabetes in Hainan is not low, especially among middle-aged and elderly people. In clinical practice, it has been found that many diabetic patients are diagnosed at a relatively late stage and often suffer from multiple complications. Additionally, due to the local diet in Hainan being high in salt and seafood, the incidence rates of hypertension and hyperuricemia have also increased. Hypertension and hyperuricemia often occur together with diabetes, and these factors combine to damage the kidneys.
Key point: the presence of these symptoms indicates kidney damage
Due to the fact that diabetic nephropathy rarely presents with pain in its early stages, its onset is very insidious. Director Chen Wen reminds us that despite its insidious nature, the kidneys will still send out some warning signals when they are damaged:
1. Foamy urine: Urine with fine and dense foam that doesn't dissipate even after a long time.
2. Increased nocturia: Frequent trips to the bathroom at night and a significant increase in the frequency of nocturia indicate that the renal tubular function is affected.
3. Edema: Mild edema and swelling of the eyelids upon waking up in the morning; some individuals may experience edema around the ankle joints in the evening, which will subside after rest.
4. Difficulty in controlling blood pressure: For individuals who already have hypertension, controlling their blood pressure becomes more challenging, and even with increased doses of antihypertensive medications, it remains difficult to manage.
5. Easy fatigue: Physical stamina decreases, and one feels very tired.
"The presence of persistent proteinuria indicates that the kidneys have been damaged," Director Chen emphasized. Microalbuminuria represents the "golden intervention window" for early renal damage; if significant amounts of proteinuria are detected, it signifies more severe kidney damage.
He emphasized that simple early-stage microalbuminuria does not cause edema. Persistent pitting edema in the lower extremities often indicates that the patient has progressed to the overt proteinuria stage, indicating a worsening of the condition. In addition, fever, infection, or strenuous exercise can also cause transient elevation of urinary protein, which needs to be carefully distinguished.
Key point: Regular screening: How often should it be conducted after a diagnosis of diabetes?
Regarding the frequency of kidney screening for diabetes patients, Director Chen Wen gave clear recommendations:
Type 1 diabetes: Screening should begin after 5 years of disease. If the results are normal, screen once a year; if renal dysfunction has occurred, recheck every 3 to 6 months;
Type 2 diabetes: Screening for kidney disease should be initiated from the day of diagnosis. If the screening results are normal, annual check-ups are recommended; if abnormal urine protein or decreased renal function is detected, follow-up examinations should be conducted every 3 to 6 months. For high-risk individuals with diabetes who also suffer from hypertension or hyperuricemia, screening is recommended every six months.
Dr. Hou Zeling also advises that it is crucial to screen for two core indicators in the early stages: the ratio of urinary microalbumin to creatinine and the glomerular filtration rate. This is because many patients may already have comorbid kidney disease on the day they are diagnosed with diabetes, but due to the absence of obvious clinical symptoms, diagnosis can be easily delayed.
At the same time, attention should also be paid to the level of serum creatinine and whether there are conditions such as "foamy urine".
Key point: Breaking the cognitive misconception: good blood glucose control does not equate to absolute kidney safety
"Does good blood sugar control necessarily prevent diabetic nephropathy? It's hard to say for sure," Director Chen Wen pointed out. In clinical practice, a significant number of patients believe that good blood sugar control ensures kidney safety, but this belief is incorrect.
He stated that achieving optimal blood glucose levels can significantly reduce and delay the occurrence and risk of diabetic nephropathy, but it cannot prevent the disease from occurring entirely. Some patients maintain their blood glucose levels within target ranges, but due to genetic factors and the inherent susceptibility of the kidneys, kidney damage still occurs. In addition to hyperglycemia, the following factors can also exacerbate kidney damage:
1. Hypertension: Long-term high blood pressure or fluctuating blood pressure can continuously impact the tiny blood vessels in the kidneys.
2. Hyperuricemia: Patients in Hainan, who enjoy eating seafood, drinking meat broth, and drinking beer, are prone to developing hyperuricemia, which can combine with kidney disease to damage the kidneys.
3. Hyperlipidemia, obesity, and long-term smoking: They can exacerbate the hardening of renal blood vessels.
4. Misuse of medication: Self-medicating with painkillers, folk remedies, and unidentified health products.
5. Infection and dehydration: In Hainan, hot weather and excessive sweating can lead to dehydration. Additionally, urinary tract infections are common in patients with diabetes, or diarrhea can cause water loss, both of which can increase the burden on the kidneys.
Key point: avoid "concentrated eating" and opt for smaller, more frequent meals to stabilize blood sugar levels
"The most taboo for patients with diabetes complicated with nephropathy in terms of diet is overeating and excessive drinking, or concentrating the entire day's meal on two meals or even one meal," pointed out Dr. Hou Zeling. Clinically, it is common for some patients with obesity to only eat one or two meals a day in order to lose weight, which can lead to fluctuations in blood sugar levels, causing significant damage to blood vessels and kidneys.
(Dr. Hou Zeling is out for outpatient service)
She suggested that diabetic patients should divide their daily food intake into more than six meals. In addition to the three main meals, they can add a small meal two hours after each meal, eating less at each meal. This can reduce blood sugar fluctuations, narrow the gap between pre-meal and post-meal blood sugar levels, avoid drastic fluctuations, and thus delay the progression of kidney disease.
When it comes to choosing fruits, Dr. Hou advises avoiding high-calorie "minefields". For instance, the currently available winter dates can contain over 125 kcal per 100 grams; tropical fruits like durian are also high in calories, and excessive consumption can lead to significant blood sugar fluctuations. She recommends opting for low-calorie fruits with 40 to 60 kcal per 100 grams, such as apples, pears, grapes, pineapples, strawberries, blueberries, bananas, oranges, and kiwis.
"However, patients with diabetic nephropathy should be even more cautious when choosing fruits," Dr. Hou emphasized. Due to the potential decline in renal function, patients are prone to hyperkalemia, and some drugs for lowering blood sugar and reducing urinary protein can also cause an increase in blood potassium levels. Therefore, on the basis of low calorie intake, it is preferable to choose low-potassium fruits such as apples, pears, grapes, pineapples, etc.
Key point: Optimal medication selection: Balance hypoglycemic and hypoproteinemic effects, focusing on core indicators
Regarding drug selection, Dr. Hou Zeling stated that for patients with diabetic nephropathy, protecting the kidneys and reducing urinary protein are key treatment points. When it comes to hypoglycemic agents, priority should be given to drugs that can reduce urinary protein and protect the kidneys.
In addition, patients with diabetes often suffer from hypertension. Among antihypertensive drugs, priority is given to those that have both the ability to reduce urinary protein and protect the kidneys. Hou Zeling mentioned that in recent years, some drugs that can reduce urinary protein, resist renal fibrosis, and have anti-inflammatory effects have emerged, which can significantly reduce urinary protein excretion and delay the progression of kidney disease.
"Nowadays, there are more and more methods for lowering blood sugar, blood pressure, and reducing urinary protein, and their efficacy is evident. However, the key is that the earlier intervention is made, the better," emphasized Dr. Hou. If it reaches the late stage of severe proteinuria, the effect will be greatly reduced, while early treatment may even have the potential to reverse it.
Key point: Can diabetic nephropathy be reversed? The key lies in which stage it is
Many patients become extremely nervous when they are diagnosed with diabetic nephropathy, fearing that it will inevitably progress to uremia. Director Chen Wen comforted them, saying, "Actually, it's not irreversible. The key is to determine the stage of the disease."
If one is in the early stage of microalbuminuria, it is considered a "golden intervention period". After standardized control of blood glucose, blood pressure, and uric acid, along with the use of kidney-protective medications, a considerable number of patients can experience reversible kidney damage, with urinary albumin disappearing and returning to normal levels.
However, if it is delayed until the stage of significant proteinuria and obvious edema, the kidneys have already undergone irreversible structural sclerosis, making it difficult to completely reverse the damage. The goal of treatment at this point is to stabilize renal function, slow down the deterioration, and try to postpone the progression to kidney failure requiring dialysis. By the end-stage renal failure, a large number of glomeruli in the kidneys have already been damaged, and patients can only rely on hemodialysis, peritoneal dialysis, or kidney transplantation to sustain their lives.
Key Point: Shifting Prevention Upstream: Comprehensive Multidimensional Management for Young People with Diabetes
In response to the trend of diabetes affecting younger populations, Dr. Hou Zeling stated that there is indeed an increasing number of young patients with diabetes and comorbid kidney disease. She advised young patients to undergo standardized early screening from the day they are diagnosed with diabetes, to ensure early diagnosis and treatment.
"To prevent the occurrence and progression of diabetic nephropathy, it is not enough to rely solely on glucose control; comprehensive management of multiple factors is also necessary," Dr. Hou emphasized at the end. All metabolic indicators affecting the kidneys, such as blood glucose, blood pressure, blood lipids, body weight, and uric acid, need to be comprehensively controlled to truly protect the kidneys. Chen Wen also stressed that early screening and intervention are key to seizing the "golden reversal period." After being diagnosed with diabetes, it is imperative to undergo regular kidney screening and not to be complacent due to "good blood glucose control.".
Source | Phoenix Hainan