A 56-year-old man from Bihar visited our hospital and said that his doctor had said all his reports were fine. His creatinine was 1.52 mg/d (upper limit 1.4 mg/dl), which he considered slightly off (“almost normal”). I calculated the exact state of kidney function (eGFR, analyzed from the formula) and told him to be careful as his kidney function was already 25% lower. , is common in patients and even some doctors.
A second common misconception is that kidney damage is caused by antidiabetic drugs. A 62-year-old woman complained that the drug you gave her called metformin had damaged my kidneys. Another Agra patient told me, “You are giving me dapagliflozin. It excretes sugar in the urine and I will soon have kidney damage and cancer.” is also wrong. Both of these drugs, especially the latter, are renal-protective. Metformin should be discontinued only if the kidneys are moderately damaged, as other side effects occur.
Renal dysfunction is not the sole fallout of diabetes. Closely associated with heart disease. Even a small increase in albumin in the urine (“microalbuminuria”) can increase the risk of heart attack severalfold. Therefore, even minor damage to the kidneys should be addressed immediately. There are several ways to do that.
First, glycemic control must be sustained over the long term, not just the short term. High blood sugar doesn’t damage your kidneys overnight, it does it quietly and slowly. Patients need to focus on lifestyle, exercise, and regular medication intake to achieve that. Some antidiabetic drugs are better than others at protecting the kidneys. Long-term studies have shown that drugs called SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin) repair kidney damage and reduce the need for dialysis. It is absolutely essential for those who are sick.
Second, blood pressure should be properly controlled. Among the many antihypertensive drugs available today, ACE inhibitors/ARBs (Ramipril, Losartan, etc.) are best suited when the kidneys are damaged and secreting protein. protein and reduce renal dysfunction.
Third, blood cholesterol and triglycerides (another form of fat in the blood) must be significantly lowered. It reduces blood flow to vital organs. Drugs that can do this job are called statins (e.g. atorvastatin) and are essential for diabetics anyway.
Diet and exercise are very important. Excess protein harms the kidneys. At no point should the patient be on a very low-protein diet, as this lowers the already low blood protein levels in the body and increases muscle and bone weakness. should be prescribed carefully and differently for each patient in collaboration with a nutritionist.
There are many other factors that can harm the kidneys, some of these are particularly common in India. Use of alternative medicines (some contain heavy metals that can seriously harm the kidneys), infections, gastroenteritis, extreme Heat, pain reliever abuse, excessive alcohol consumption, high uric acid, etc. should be avoided/treated at all costs. All obese patients should lose weight to improve renal function.
Kidneys in diabetic patients require special care. Even if it is damaged, it can be repaired. An early warning of severe renal dysfunction is given by the urinalysis “microalbuminuria”. This test should be done annually for all people with diabetes. The presence of this small amount of protein in the urine requires initiation of an individualized diet, exercise, weight loss, tight control of blood sugar, blood pressure, and lipids, and the use of kidney-beneficial medications.
(Author is Padma Shree laureate and author of the book “Diabetes with Delight”)