“Ask Dr. HKSH” - Diabetic Nephropathy

Dr. LAI Kar Neng

Specialist in Nephrology

Q1.  Does having diabetes mean you will develop diabetic nephropathy?

Diabetes is primarily divided into two major types. The most common is Type 2 diabetes, often referred to as “maturity-onset” diabetes, with onset typically occurring between the age of 30 and 50. It is mostly manageable with medication. A small number of patients have Type 1 diabetes, and need insulin injections from a young age. They are more likely to have kidney problems due to diabetes than those with Type 2 diabetes.

However, kidney failure may only occur if diabetes remains poorly managed for over a decade, whether it is Type 1 or Type 2 diabetes. If one with well-managed diabetes still has kidney disease, the pathological diagnosis is often not “diabetic nephropathy”, but another condition with some other causes. Therefore, it is essential to distinguish between them clearly.

Q2. Does diabetes inevitably lead to kidney failure?

Diabetes is a common cause of kidney failure. A local study showed that among patients on dialysis, 51.7% had kidney issues due to diabetes. Thus, without proper management, diabetes can significantly impact kidney health and become a major cause of kidney failure. However, if patients can effectively control their blood sugar levels, it can significantly reduce the risk of kidney failure.

Q3. How can I reduce the risk of diabetic nephropathy?

It is crucial to achieve normal or near-normal blood sugar levels. Other factors, such as poorly controlled blood pressure, also affect diabetes. Most diabetic patients also suffer from high blood pressure or uric acid issues, all of which require proper management. However, if patients fail to control blood sugar and take medication as prescribed in terms of frequency and dosage, they may have protein in the urine.

Treatment may differ from the existing one when protein is found in the urine. If the protein concentration is excessively high in urine, i.e., 10 times or above the normal level, the kidney function could deteriorate rapidly within two years, even leading to dialysis. Therefore, control of both blood sugar and urinary protein levels is very important.

Moreover, as diabetic nephropathy develops, it may also damage the cardiovascular system, ocular blood vessels and nerves. Patients must be extra careful when diabetic nephropathy comes with other complications.

Q4. I am diabetic and have been on dialysis for years. Is kidney transplant a permanent solution?

No. It is important to understand that a kidney transplant is not a permanent solution. Two complications may arise after transplant. First of all, patients may need to take multiple immunosuppressive medications. They may end up with an immune system 50% weaker than that of a healthy person, and are at a significantly increased risk of infections. They must take extra precautions in daily life. Second, some kidney conditions may recur after kidney transplant, often as a result of poorly controlled diabetes. What kidney transplant can do is to give patients a new hope. If you fail to manage the diabetes or adhere to the prescribed treatment plan, kidney transplant is definitely not a “once-and-for-all” solution.

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