Understanding Diabetic Kidney Disease: Prevention, Early Signs, and Treatment

This article was contributed by Dr. Wong Joon Mun, Consultant Internal Medicine & Nephrology at Pantai Hospital Klang.
To book an appointment or learn more about Dr. Wong Joon Mun and his clinic, click here.

Q: What is Diabetic Kidney Disease (DKD)?
A: Diabetic Kidney Disease, also known as diabetic nephropathy, is a serious complication of diabetes where high blood sugar levels damage the kidneys over time. This can lead to reduced kidney function and, if left untreated, progress to chronic kidney disease or kidney failure.

Q: How common is Diabetic Kidney Disease in Malaysia?
A: Diabetic Kidney Disease is becoming more prevalent in Malaysia due to the rising number of people with diabetes. Currently, approximately 40% of people with diabetes may develop some form of kidney damage, making DKD one of the leading causes of chronic kidney disease nationwide.

Q: What are the main causes of Diabetic Kidney Disease?
A: The main causes of DKD are prolonged high blood sugar levels and uncontrolled high blood pressure, both of which damage the blood vessels in the kidneys. Lifestyle factors like smoking, being overweight, and not managing diabetes well also contribute to the risk.

Q: What are the early signs of Diabetic Kidney Disease?
A: In the early stages, DKD may not cause any noticeable symptoms. The first warning sign is often the presence of protein in the urine, detected through routine urine tests. As the disease progresses, symptoms like swelling in the feet or ankles, tiredness, and high blood pressure may develop.

Q: How can Diabetic Kidney Disease be prevented?
A: Prevention of DKD relies heavily on good diabetes management. Steps to prevent or delay the disease include:
- Keeping blood sugar levels within the target range.
- Maintaining a healthy blood pressure.
- Adopting a low-salt, balanced diet.
- Exercising regularly.
- Quitting smoking, which can damage blood vessels further.
- Having regular blood and urine tests to monitor for any early signs of kidney damage.

Q: When should a person with diabetes seek a specialist in nephrology?
A: People with diabetes should consider seeing a nephrologist if:
- Routine urine tests show high levels of protein (albumin)
- They experience symptoms like frothy urine, persistent swelling in the legs or feet, high blood pressure
- Their general practitioner or endocrinologist identifies declining kidney function in test results.
- They have a family history of kidney disease.
Seeking a specialist early can help manage the condition effectively and prevent further complications.

Q: What treatment options are available for Diabetic Kidney Disease?
A: Treatment focuses on lifestyle changes, diet modifications, controlling blood sugar and blood pressure to slow down the progression of DKD in order to delay or avoid the need for dialysis or kidney transplant. This may include:
- Medications like ACE inhibitors, ARBs or SGLT2 inhibitors to protect kidney function.
- Dietary adjustments to reduce salt and protein intake.
- Regular monitoring of kidney function through blood and urine tests.
In advanced cases, dialysis or kidney transplantation may be needed.

Q: How often should someone with diabetes get their kidneys checked?
A: People with diabetes should have their kidney function checked at least once a year, even if they don’t have symptoms. Regular testing can detect any early signs of kidney damage, allowing for prompt treatment and management to slow the disease's progression.