The slogan of World Kidney Day on March 1, 2010 was adopted as "Control your diabetes well, protect your kidneys". The number of diabetic patients is increasing rapidly in the world and in our country. In addition, chronic kidney patients are increasing rapidly and this increase is unfortunately due to the chronic kidney disease seen in diabetic patients, which we call diabetic nephropathy (DN). We would like to address this dangerous disease, which, with a rapid course, eventually turns the patients it affects into dialysis patients.
Diabetic nephropathy is a common problem: There are around 60 thousand patients with end-stage renal disease treated with dialysis and kidney transplantation in Turkey as of the end of 2012. About 50 thousand are on dialysis, but about 10 thousand live with a functional transplant kidney. Every year, about 10%, that is, around 5 thousand new diabetic patients are added to this number. Diabetic patients are in the first place with a rate of 30% among both the patients who have just started treatment and those who are still under treatment. Perhaps more important than this is the fact that only 12% of the 11 thousand dialysis patients 10 years ago were diabetic. At least 30% of people with Type I diabetes, which usually start in childhood and mean absolute insulin deficiency, develop minimal protein leakage, which we call microalbuminuria, the first sign of diabetic nephropathy, and just under half of them develop significant protein leakage or established DN. Since the onset of diabetes cannot be determined well in Type 2 diabetes, which starts in adulthood and we see more commonly, it cannot be said how long this rate will be. For example, in one study, while DN was observed in 32 patients per year in 1000 patients in the 90s, this rate decreased to 15 in the 2000s. However, when we consider the prevalence of Type 2 diabetes and its rapidly increasing number due to increasing obesity and inactivity, the frightening situation I mentioned above still exists.
Diabetic nephropathy progresses rapidly: In the early period of DN, it manifests itself with a symptom called microalbuminuria, which is detected only by a special method. Then, this situation progresses to a protein leakage of more than 3-5 gm per day, which is detected even with routine urine analysis. Hypertension is usually not started before this period. sion is also added to the table. Then, a rapidly developing loss of kidney function and finally being a dialysis patient occurs. The most serious problem of these patients is a serious salt and water accumulation and a problem of shortness of breath that develops with left heart failure and fluid accumulation in the lungs accompanying the high blood pressure caused by this. Therefore, most patients need to be taken to emergency dialysis treatment before their urea and creatinine levels increase too much. Therefore, it has become a rule to prepare for dialysis early in these patients.
Diabetic nephropathy can be prevented: If the person has diabetes, first of all, he should accept this fact and fulfill the requirements of this disease. Unfortunately, the cost is heavy when diabetic control is not performed in patients. Control of blood sugar is the most important measure in the beginning. The key to this is primarily not to gain weight or to lose weight if we are overweight, and to take a moderate diet consisting of flour and sugar foods in 5 meals throughout the day. Oral medications at the beginning, but as the age of diabetes increases, even if sugar control is good, timely switching to insulin therapy will accompany the diet. HbA1C (glucosylated hemoglobin) levels, which is a test showing 3-month sugar control, should be checked every 3 months and should be kept below the 6.5% target. A common mistake we encounter in diabetic patients is monitoring the patient by only looking at their blood sugar. Some of the patients even do this job on their own and do not even follow a doctor. However, these patients should be followed closely in terms of hypertension, cardiovascular diseases, capillary changes in the base of the eye, eye retinal diseases that cause bleeding and blindness, and peripheral nerve disease, which leads to a dangerous process leading to diabetic foot amputation of the leg or arm. A simple urinalysis is one of the most important tests to be done. Better still, for the early diagnosis of protein leakage in the urine, the determination of microalbuminuria and creatinine in the urine together or the total amount of microalbumin in 24 hours is extremely important for the early diagnosis of DN.
Diabetic dialysis patients can also get a kidney transplant: Diabetic patients can get a kidney transplant. there is no obstacle. The life expectancy of transplanted patients is better than those undergoing dialysis. A significant portion of chronic kidney failure patients who do not have diabetes before kidney transplant surgery develop diabetes after the transplant due to the drugs that have to be used.
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