 Hello everyone, today we are discussing about the kidney disease and the diabetic nephropathy we call it So we'll talk about how and why it happens and symptoms of diabetic kidney disease And we're gonna touch based on the stages of the kidney disease The risk factors, how to prevent and how to not end up with dialysis And we're gonna talk about dietary measures at the end So it's not a very super short video, but it's not very exhausting either So if you really want to get to the bottom of this issue, you better stick around until the end of this video And you will be a pro, I promise, understanding the kidney disease Let's get started I'm Dr. Ahmed Ergen, I'm an endocrinologist who has great passion in helping people with diabetes all around the world As you may know, diabetes is the leading cause of kidney disease At least in the USA About one third of patients with diabetes currently has kidney disease, whether they know or not More commonly, my relatively new patients have little to no idea until I tell them that they have kidney disease They get upset because they just didn't know or didn't hear that from their GP before And I'm the bad guy just breaking the news The unawareness is so common among the people that even with stage 4 kidney disease, they have no idea Less than 40% of these individuals are aware of their disease I want my patients to know everything about what is going on Anyhow, diabetic nephropathy affects your kidney's ability to do the usual work of removing the waste products and extra fluid from your body As a result, you start feeling sluggish, tired and swollen when those substances are not removed The best way to prevent or delay the diabetic nephropathy is by maintaining a blood sugar as close to normal as possible And treating your cholesterol, obesity and high blood pressure Easier said than done, right? We'll talk more about that later This, though, diabetes slowly damages your kidneys Acting early may prevent or slow the disease progress and reduce the chance of ending up with dialysis When your kidney disease progresses to total kidney failure, we call that end-stage kidney disease At that point, patients will need dialysis permanently The whole purpose of this video is that you guys hopefully will not need to go to dialysis after understanding this disease process and taking the appropriate actions But more than 50,000 people with end-stage kidney disease from diabetes are on dialysis right now in the US So do not wait for your doctor to do something Like I said, half the time, your doctor may not even tell you that you have kidney disease until you have stage 4 kidney disease Don't ask me why That brings us to the stages of kidney disease, so let's talk about that So most of the time, doctors will detect a protein in the urine as a first sign of chronic kidney disease So that's like even before any stage At that stage, your GFR, which is your glomerular filtration rate, will possibly be normal or even higher than expected So do not assume that your kidneys are completely normal because your GFR is not highlighted in red on your report So don't try to doctor yourself So when your albumin is in the urine is between 30 to 300 mg per gram, you have something called microalbuminuria If the number goes above 300, then we call that macroalbuminuria Should this happen, the worsening of chronic kidney disease becomes faster So normal kidney function, look at the GFR, is considered to be above 90 When the GFR goes between 60 and 90, this is called stage 2 kidney disease When your GFR goes between 30 or goes below that 60 range between 60 and 30, that's stage 3 So when the GFR is between 15 to 30, that is stage 4 And the GFR below 15 is stage 5 kidney disease So most patients with GFR below 15 will need dialysis unfortunately And stage 5 and lower GFR is definitely life-threatening unless you go to dialysis At that stage, you basically are left with dialysis as the only option So what does your kidneys really do and what happens when they fail? Well, the main job of kidneys is to filter wastes and extra water out of your blood And it makes urine Your kidneys also help control the blood pressure and make hormones such as aldosterone, adrenaline and renin To help regulate the blood pressure When your kidneys are damaged, they cannot filter blood like they should Which can cause wastes to build up in your body These toxic substances that accumulate in your body can also cause other health problems such as heart failure Or even cardiovascular disease that includes the heart attacks or strokes, god forbid So, let's review how the damage to kidneys happen with diabetes Well, first of all, high blood sugars in your bloodstream causes your blood cells to become sticky They tend to stick to one another and along the sides of the blood vessels The blood vessels then become inflamed which attracts even more inflammation and inflammatory chemicals to the area This makes the inflammation even worse because it becomes a vicious cycle Remember, how I said the insulin resistance was also a major culprit in causing the problem? It's because of fatty acids This means that you are having these blood vessel changes even before you have the real diabetes So then fatty acids and glucose attach the endothelial wall on your kidney arterioles Which are the small arteries within the kidneys They become larger and the blood flow increases to the kidney The whole filtering system is affected This lasts only a short while before the kidneys begin to burn out That is when you start having chronic kidney disease Because healthy cells in the kidney die of pretty early in the diabetic kidney disease The blood flow unfortunately starts to drop and we measure the blood flow through the kidneys using what? You just learned GFR, the glomal infiltration rate You can find your GFR on your lab test where the kidney testing is reported Where the creatinine and BUN are basically a CMP or BMP There will often be two values, one for African Americans and one for all others Find the one that fits you and look it up on that stage See where you are fitting as we discussed before Another important thing that happens in the diabetic kidney disease is that the glucose absorption increases That means that even if the glucose is filtered in the urine It gets reabsorbed easily back into your bloodstream This causes the blood sugar to remain high And at this point kidney's ability to excrete the excess sugar is also gone So what are the other names for diabetic kidney disease? You can call it a diabetic kidney disease as DKD in short or CKD Or you can call this kidney disease of diabetes or diabetic nephropathy So now you all know all the terms about that Let's talk about whether you are at risk for kidney failure Well if your age is increasing which happens to everybody, that's a risk factor And if you're older than me, that's definitely a risk factor So the longer you have diabetes and other risk factors The more chance is there to develop diabetic kidney disease Now interestingly something that you cannot control which is race and ethnicity can be a risk factor So if you're an African American Latino or American Indian You are at higher risk unfortunately Interestingly chronic kidney disease due to diabetes is more common in women than men Now diabetic kidney disease is also more common in people with a low socioeconomic status Unfortunately people with low socioeconomic status tend to see doctors less often Unfortunately they also tend to be less educated to prevent kidney disease Another one is obesity as a risk factor It's been listed as an independent risk factor even without diabetes So diabetic patients who are overweight are definitely adding more risk for diabetic kidney disease If they are morbidly obese Just like obesity smoking can also be a huge risk factor Independent of diabetes And when combined with diabetes smoking can be super detrimental to your kidney function If you have diabetes and your blood sugars remain high for years and years That will definitely put a huge toll on your kidneys Now high blood pressure is also extremely important in the progression of kidney disease So do not please do not ignore your blood pressure and keep it under control The best blood pressure for kidneys is any blood pressure below 120 over 80 As in many diseases genetic factors also contribute to the development of the kidney disease Especially due to diabetes So if your family members developed kidney disease or kidney failure due to diabetes You have to be extra careful So acute kidney injury also is another thing that happens sometimes on top of chronic kidney disease That also acutely lowers your kidney function and it may not come back So those people are generally dehydrated And make sure that they understand that the hydration definitely can trigger acute over chronic kidney disease So if you're on drugs like Jardines, Farsiga or Turlicity You have to be a little extra careful for not to get dehydrated So how can I tell if I have diabetic kidney disease? Like what are the symptoms? So most people with diabetic kidney disease do not really have symptoms Unless you are in acute kidney failure You will have very little to know your nation But with chronic kidney disease It does not really give symptoms until it's like late stages The only way that you know if you have diabetic kidney disease is to get your kidneys checked In my clinic I always monitor kidney function regularly Along with the A1C values and the cholesterol, etc How to manage prevent and treat diabetic kidney disease then? Well, number one, control blood sugars So when it comes to controlling blood sugars As an endocrinologist, I always aim for as low as reasonably achievable for blood sugars That means that we strive to keep the blood sugar as close to normal as possible Without causing significantly low blood sugar Which in other words is hypoglycemia Keeping A1C less than 7 and if possible less than 6.5 Is the ultimate goal for most younger patients For patients over 80 years of age Then for them if they have too many problems It may make it more difficult to prevent a low blood sugar And in that case A1C goal sometimes is a little higher Remember continuous glucose monitoring systems such as DEXCOM and Freestyle Libre Are extremely helpful to prevent low blood sugars Especially if you are already experiencing that They also help to control high blood sugars because it gives you the data that you have been looking for Number two, the blood pressure control Well, intensive blood pressure control is extremely important in addition to your blood sugar control Remember the magic number is 130 over 80 Keep it at that or lower Blood pressure control only reduces kidney disease progression I mean not only it reduces kidney disease progression But also it reduces the death from cardiovascular disease such as stroke and heart attacks You should also know that the chronic kidney disease itself is a risk factor for heart attacks and strokes Also remember most patients die from heart attacks and strokes Even before they end up with dialysis due to chronic kidney disease So preventing heart disease and strokes should be important The most common agents we use for blood pressure and blood pressure control in patients with diabetes Are called ACE inhibitors or angiotensin receptor blockers So talk to your doctor about that Number third is the obesity So obesity and diabetic kidney disease is a very important The obesity alone is a huge risk factor as we discussed previously So try to do your best to try to keep your weight as low as possible So cholesterol, now reducing cholesterol level especially the LDL is extremely important So don't listen to those guys saying that oh LDL is good for you That's total BS, okay Most people resist the idea of cholesterol medications based on what they hear or see on the internet or TV Please read from reliable resources and watch people with credible credentials I have not yet met a credible endocrinologist or a cardiologist Who claim that the high LDL is okay for you Nor I read a credible study showing that high LDL is okay either So I don't know where these people are getting their information from Here is a diet question Do I need to reduce protein in my diet? Especially if I have chronic kidney disease Well, the role of protein restriction is really unclear unfortunately But I would still avoid excessive protein and try to stick to run 50 to 60 grams of protein daily Which is the commonly recommended protein amount by most nephrologists and the organizations for kidney disease So how often to monitor diabetic kidney disease? Patients with chronic kidney disease, especially these are diabetes should be seen by their doctors And have a follow up every 3 to 6 months I prefer 3 months Now the endocrinologist or diabetes specialist will review Not only the labs but also blood pressure control and review the medications that may need to be changed if necessary In our diabetes center we target the A1C, the blood pressure, the blood cholesterol control all together in a holistic way This approach is the most effective approach to reduce the chronic kidney disease not only to control the blood sugar So here's another question How soon will I go to dialysis when I have chronic kidney disease? That's an extremely common question Well, not all the individuals have progressive loss of kidney function, that's the good news So some studies show a high rate of progression while the others report a relatively stable disease And again, most studies indicate that the blood pressure cholesterol control makes or breaks it That also depends on the degree of chronic disease as well And all the risk factors we just discussed Patients who have good glucose control, the good blood pressure control and the cholesterol control are very lucky Because they typically stay stable Especially if they are on the right medications to prevent kidney disease The chances of progressing to dialysis is way way lower So guys, thank you for watching And I hope you do not have kidney disease And if you do, I hope it just remains stable or even get better So, if you like this video, give a thumbs up, share and like And we'll see you in the next video