Diabetic nephropathy (also known as diabetic kidney disease) is the medical name given to the damage that diabetes causes to the kidneys, which can be brought about by both type 1 (a hereditary disease) and type 2 (usually due to lifestyle) diabetes. In time, diabetes that is poorly monitored and managed can cause damage to the blood vessels in your kidneys, which get rid of waste products in your blood. This can lead to kidney disease.

While this may sound frightening if you are diabetic or pre-diabetic, remember that your body is a system, and you can maintain and manage that system with love and care.

How many people have this problem?

Diabetic kidney disease affects 20-40% of all diabetics, and currently there are about 350 million people in the world with diabetes, which is expected to rise to a whopping 550 million by 2035. People of African, Asian and any Aboriginal descent (for example, Native Americans) are more susceptible to diabetes, and are more likely to develop end-stage kidney disease, though this does not mean people of Caucasian descent are in the clear, with an increase in cases for all race groups. A study in Germany, where the population is predominantly Caucasian, found that 59% of patients who needed dialysis or a kidney transplant had diabetes, with 90% of those having type 2 diabetes.

South Africa has seen a significant increase in diabetes cases over the past few years, with well over 2 million people who suffer from diabetes. Some 95% of people who are type 2 diabetic start to develop kidney problems within 10 years of developing diabetes.

How does diabetes damage the kidneys?

Diabetes is the inability of the body’s cell to take up and break down sugar due to insulin resistance. Glucose (sugar) is needed by the body to make the cells work, as it is the source of energy. If cells become resistant to insulin then this sugar remains in the bloodstream, where it starts to cause damage. That is why we used to call it sugar diabetes.

Being the brilliant machine that it is, the body will try to get rid of this excess sugar, which means it needs to be filtered through the kidneys so that it can be excreted through the urine. The filtration system that the kidneys use is millions of little blood vessels which filter this sugar out of the blood. But in the process, they get damaged. It’s similar to when the fuel filter on your car gets clogged – it won’t let enough fuel through to make the car go. The kidneys become damaged and then cannot filter out the toxins in your body, and this is detected by an increase in protein in your urine, which indicates to your doctor that your kidneys are not working properly.

So, the number one reason for your kidneys to start to act up is excess sugar in the blood, known as hyperglycaemia, which is caused by diabetes, which in turn is caused by the body’s inability to break down sugar properly due to an insulin resistance.

What are the risk factors for kidney disease?

Hypertension (high blood pressure), obesity, poor glycaemic (sugar) control and duration of disease are the main factors that increase the risk of chronic kidney disease in Africa, though this is common with other parts of the world. Sedentary lifestyles, caused by us sitting all day and getting little to no exercise, plus easy access to sugary foods and junk food, are causing a global epidemic of people who are either diabetic, pre-diabetic or have metabolic syndrome, and are thus prone to sugar resistance which can lead to kidney disease. Some 87% of diabetes cases in South Africa are attributed to being overweight, and this is a growing problem in the country.

How will I know if I have kidney disease?

The only way to know for sure is to go to your doctor and have a urine protein test done. If your doctor discovers that there is protein in your urine, then this may indicate that your kidneys are giving you hassles.

Symptoms that you could have kidney disease can include the following:

• Frequent need to urinate
• Foamy urine or blood in the urine
• Fatigue, lack of energy and trouble concentrating, ironically coupled with difficulty sleeping
• Loss of appetite
• Swollen hands, feet and ankles
• Numbness, dry and itchy skin, and darkening of your skin
• Nausea or vomiting
• High blood pressure

Do not be alarmed if you have these symptoms, which may be caused by any number of factors. Make an appointment with your doctor to determine your state of health.

What can I do to help my body?

Here are 5 simple things you can do to help your body along:

Control your diabetes

If you have diabetes, then you need to see your doctor to get this under control immediately. This may include taking medication, or lifestyle changes to help you manage this disease. If you are pre-diabetic or have metabolic syndrome, then you need to work to prevent this from escalating into full-blown diabetes.

Ease up on the sugar

There is very strong evidence that one of the reasons you developed type 2 diabetes in the first place is an excess of sugar in your diet. For thousands of years, human beings functioned perfectly well without sugar, which occurs naturally in many foods anyway, such as fruit and vegetables. But we have developed a taste for the processed sweet stuff, and even though it is legal, sugar is a bit like a drug and it is addictive. That’s one of the reasons why South Africa now has a sugar tax! The key here is moderation: the body needs some sugar, but it does not need an entire big slab of chocolate in one sitting.

Water. Aqua. Amanzi. H20. Adam’s Ale.

Call it what you will, but water is purity for the body. It allows excess sugar (glucose) to be flushed out of the blood more easily. Drink water instead of sugary drinks when you are thirsty. Like taking a shower, water has an amazing ability to wash your insides clean.

Watch what you eat, and control your weight

Sometimes healthy eating is just better planning. If you make a sandwich and take it with you to work for lunch, then the pie from the canteen is less likely to grab your eye, and the biscuits with tea are also less appealing. Having a body mass index (BMI) over 25 puts you at risk for developing diabetes and thus kidney disease – especially as you get older.

Get moving, but remember to socially distance (and wear your mask)

Take a leaf out of Taylor Swift’s book and shake it off. Regular exercise, which needn’t include an expensive gym contract, has proven health benefits. Walking for just 150 minutes a week (30 minutes a day for 5 days or 25 minutes for 6 days) has been shown to boost your body’s levels of health and increase your lifespan. However, bear in mind that people with diabetes are more at risk if they contract Covid-19, so be careful in public spaces and with people who may have been exposed to the disease.

Chat with your doctor about your concerns around your kidneys and diabetes, even if just for your peace of mind. There is no reason to delay getting treatment during the pandemic. All hospitals are fully equipped to protect their patients from the risks of COVID-19 and Lenmed urges you not to neglect your health.

The lenmed Group is a world-class chain of Private Hospitals that brings quality healthcare to communities across Southern Africa.

For more information please contact:

Dr S Moholo, Specialist Physician
MBChB (UFS), MMed (INT) (UFS)
Zamokuhle Private Hospital
Tel: +27 (0) 11 923 7825
Email: [email protected] or [email protected]

Disclaimer: Any information contained here is merely a guideline. Always visit your healthcare practitioner for any health-related advice or diagnosis.