Protect Your Kidneys: The Silent Organ

Chapter 33 · Vihang Rahul Vasa

Most people never think about their kidneys until a doctor says the word “dialysis.” This chapter exists so that you never have to hear it. The kidneys are two fist-sized filters that clean the blood, day and night, without ever complaining. That silence is the danger. Medical research reports that diabetes is the leading cause of kidney failure in India and across the world.

How diabetes hurts the kidneys. Each kidney is made of millions of tiny filters, fed by the smallest blood vessels in the body, the same micro-vessels that diabetes damages in the eyes. Years of high plasma glucose (blood sugar) can scar these filters. High blood pressure, which so often travels with diabetes, adds a second blow. The damage is slow and quiet, and it can go on for years.

Why you will feel nothing. In my experience, this is what people find hardest to believe: a kidney can lose a large part of its working strength before a single symptom appears. When symptoms finally come, swelling of the feet and ankles, frothy urine, passing urine more at night, tiredness that will not lift, loss of appetite, a lot of ground has already been lost. Do not wait for symptoms. There will not be any until it is late.

The two tests that see it early. Only two simple tests catch kidney damage while it can still be slowed: a urine test for microalbumin (a protein that leaks into the urine when the filters begin to fail: the earliest warning of all) and a blood test for creatinine, from which the doctor calculates how well the kidneys are working. Both are explained in the tests chapter (see Chapter 10). Medical guidelines advise them at least once a year for every person living with diabetes; your doctor will set your frequency. If either is abnormal, the doctor may adjust your medicines: do not change anything on your own.

What protects the kidneys, in my experience. Plasma glucose (blood sugar) in range. Blood pressure in range: for the kidneys, this matters as much as the sugar. No smoking. Less salt. Enough water, unless your doctor has told you otherwise.

Medicines that can harm the kidneys. A warning most people never hear: some common painkillers, taken often, are hard on the kidneys. So are some antibiotics, the contrast dye used in certain scans and angiography, some blood-pressure medicines that make you pass more urine (diuretics) when you are dehydrated, and some herbal or “traditional” preparations. In a person living with diabetes, never take painkillers for days on end, and never start any of these without telling the doctor that you live with diabetes: ask which ones are safe for you. Before any scan or procedure that uses contrast dye, tell the doctor about your diabetes and your latest kidney results.

When the kidneys weaken, the medicines change. Many medicines, including some for diabetes, and some blood thinners, are cleared from the body by the kidneys. If the kidneys slow down, doses may need adjusting, and a few medicines may need to stop. This is why every doctor who prescribes for you must know your latest kidney results. Carry them in your phone (Chapter 14).

The message is simple: kidney damage from diabetes is largely preventable, and largely irreversible once it has happened. Test every year. Control the plasma glucose (blood sugar) and the blood pressure. And ask your doctor, at least once, the question I ask my doctor: “How are my kidneys?”

(References for this chapter, kidney disease in diabetes, screening, protection, and medicines that can harm the kidneys, are listed in Appendix B.)

Illustration: Chapter 33 illustrated summary. Kidneys work quietly and changes can be silent.

Chapter 33 Kidneys work quietly and changes can be silent. Illustrated monitoring includes urine microalbumin, blood creatinine, plasma glucose and blood pressure, with doctor-led medicine review.

Chapter at a glance: an AI-generated illustration to be read with the chapter, not instead of it. The people shown are not real.