Our kidneys are our organs that ensure the fluid and electrolyte balance of our body, maintain blood pressure balance with the hormones they produce, protect bone health, and regulate blood production. Our kidneys filter all the blood in our body every 5 minutes, that is, more than 250 times a day. While they do not excrete useful substances, especially proteins, they excrete harmful substances through urine.
In our country, 15.7% of the adult population (approximately 8 million people) While 61,000 people have mild or severe kidney disease, they receive dialysis treatment and 12,800 people continue their lives with a kidney transplant. Risk factors for permanent kidney disease; diabetes, hypertension, family history of kidney disease, urinary tract stones, urinary tract obstructions, autoimmune diseases such as SLE, obesity, low socioeconomic status and smoking. In our country, according to the data of the Turkish Nephrology Association, the most common cause of kidney failure in patients on dialysis is diabetes with 41%, while the second most common cause is hypertension with 25%. The rate of nephritis originating mainly from the kidney in dialysis patients is 7.9%, and polycystic kidney disease is 3.8%. The most important reason for the increasing incidence of kidney failure in recent years is the increasing incidence of diabetes and hypertension. The country with the highest diabetes development rate among European countries is Turkey. While the prevalence of diabetes was 7.3% in the TURDEP-1 study conducted in 2000 in our country, this rate increased to 13.7% in the TURDEP-2 study conducted in 2012. While the rate of hypertension in our country is 30% in the population over the age of 18, it was found to be 58% in middle-aged women between the ages of 50-59 and 50% in men (PATENT-2 study, 2012).
High blood sugar in diabetic patients, Large and small blood vessels are damaged due to oxidative stress and the formation of toxic substances called advanced glycosylation products. The organs that are most easily and quickly damaged are the kidneys, eyes, heart and brain, which are rich in vascular networks. Due to damage to the vessels and kidney tissue in our kidneys, protein leakage occurs in the urine. If not diagnosed early, protein leakage causes permanent kidney function failure over time. In those with kidney function below 20% and protein leakage, within 10 years The risk of death in people with diabetes is approximately 6 times higher than in people in the same age group.
In a study conducted in 2014, after screening 940 Type 2 diabetic patients for kidney disease, 54% had mild or advanced stage kidney failure. It was found that only one-fifth of the patients were known to have kidney disease before screening, while four-fifths were not aware of protein leakage and kidney failure. The most important reason for this is that protein leakage and renal failure progress silently until the very advanced stages, that is, they do not cause any clinically significant complaints. Therefore, the easiest way to detect kidney failure early is to regularly monitor the population at risk.
The health journey of diabetes and hypertension patients who develop kidney failure is like ships trying to pass through bottlenecks. There are many dangers hidden in the paths of these patients, the main ones being an increase in cardiovascular diseases due to disruption of calcium and phosphorus metabolism, anemia due to weakening of bone marrow function, drug toxicities due to improper adjustment of drug doses (approximately two-thirds of drugs are excreted through the kidneys), fluid accumulation in the body. It is the risk of sudden death due to heart failure and fluid accumulation in the lungs and sudden increase in potassium. For this reason, patients with diabetes and hypertension need the guidance of a nephrologist to overcome these bottlenecks against kidney failure and its associated dangers.
Basic things to do in patients whose kidney functions begin to deteriorate; restricting excessive protein and salt intake, regulating lifestyle changes, ensuring fluid intake balance, taking early precautions against urinary tract infection, urinary tract obstructions and bladder dysfunction, very well monitoring the use of medications, especially radiocontrast agents and painkillers, diabetes. It is the adjustment of insulin doses and hypertension medications according to kidney failure, and the risk factors that increase cardiovascular diseases such as dyslipidemia, smoking, obesity, anemia, phosphorus and potassium levels are carefully examined and corrected. In the early stages, the disease is difficult to diagnose but easy to treat, while in the advanced stages, it is easy to diagnose but difficult to treat and its consequences are severe. For this reason, it is useful to regularly monitor patients in the risk group, especially diabetes and hypertension patients, for the development of kidney failure.
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