Category: General

Yes. People with diabetic kidney disease (DKD) are advised to follow a low protein diet (LPD) which helps to maintain good nutritional status, reduce the negative effects on high blood urea, improve metabolic alterations, and reduce proteinuria. In the very early stages of DKD, a balanced diet which helps in glucose control is preferred.
For people with moderate degree of kidney function and with diabetes, it is reasonable to have a dietary protein intake of 0.60–0.80 gram of dietary protein for every kilogram of body weight daily. This will help maintain a stable nutritional status and keep blood glucose under control.
Based on the condition of the person with diabetic kidney disease, restrictions may be needed in the intake of minerals such as phosphorous, sodium & potassium. It is important that these changes be sustained long term and modified according to the health condition of the person. A team of doctors and dieticians are needed to frequently monitor patients on protein restricted diet and provide comprehensive nutritional support to lessen the declining kidney function and improve health.

Author
Hima

This is a very common myth and can sometimes lead to fear in the minds of people with diabetes. It is not uncommon to see people refusing to take medicines or insulin due to this fear.
Not only are diabetes medicines safe, but some medicines also have protection for the kidneys. People with diabetes are at risk of developing diabetic kidney disease (DKD) if their blood glucose levels and blood pressure are not optimally controlled. Hence diabetes and hypertension, along with smoking are responsible for increasing risk of kidney disease.
However, once a person develops DKD, the doctor may alter the dose of some of these medications used for diabetes. This is because these drugs are excreted out of the body by the kidney and the blood levels of these drugs may increase in kidney disease. Some of these drugs must be stopped or dosages altered according to the kidney functions of that person. Pain killers (NSAID group) should preferably be avoided, and some antibiotic dosages need be modified. It is not the diabetic medicine which is the real reason for DKD but rather it is the uncontrolled long-term blood glucose which is the culprit for the increased risk of DKD.

Author
Dr. Deepa

Diabetic kidney disease can be silent for a long time before it is diagnosed. People with uncontrolled blood glucose, higher blood pressure, those who smoke and those who are overweight are at high risk of developing kidney disease. The damage to the kidneys starts well before any of the tests shows any abnormality.
The kidneys can leak albumin(protein) and it is called albuminuria (proteinuria) and is detected by tests of urinary albumin. Once the function of the kidneys starts deteriorating, the creatinine starts increasing. However, the creatinine may remain within the laboratory range even if a substantial part of the kidney function is lost. So, we calculate estimated glomerular filtration rate (eGFR) to assess the same. The eGFR is a measure of how well the kidney filters blood. Normal eGFR rates are more than 60 ml/min/m2. A GFR less than 60 may mean the kidneys are not functioning well and below 15, it suggests kidney failure.
An ultrasound of the kidney may be done to exclude other causes of kidney disease. Since the kidneys have other functions, your doctor may check tests like blood urea, electrolytes, uric acid, and hemoglobin to know if they are affected.

Author
Dr. Mathew John

Diabetic kidney disease (DKD) is a complication of diabetes – both type 1 and Type 2 diabetes. It leads to a decrease in kidney function that occurs in some people who have diabetes. It means that your kidneys are not able to function as well as they once did to remove waste products and excess fluid from your body. In the early stages, there may not be any symptoms. The symptoms at first tend to be vague and nonspecific, such as feeling tired, having less energy than usual, and just not feeling well.
As kidney function decreases further, patients may experience various signs and symptoms like swelling of feet, ankles, hands, or eyes, increased need to urinate, difficulty concentrating, shortness of breath, loss of appetite, nausea and vomiting, persistent itching, fatigue, reduced need for insulin or diabetes medicine and worsening blood pressure control. The presence of frothing of urine is an important sign of diabetic kidney disease. Sometimes high blood pressure which is difficult to control may be a sign of progression of kidney disease. Many people with DKD also have diabetic retinopathy (diabetes affecting the eye). Hence screening the eye is an important part of managing people with DKD.
Since DKD does not cause symptoms in early stages, it is important to get the blood glucose and blood pressure controlled consistently. Even in the absence of any symptoms, it is important to see a doctor regularly and undergo periodic check-up of blood pressure, urine (for protein), kidney functions and screen for complications.

Author
Dr.Tittu Oommen

In people with diabetes, kidneys, eye, nerves, and heart are the commonly affected organs. The prevalence of chronic kidney disease in India is found to be 15-17% according to the latest statistics. Diabetes is the leading cause of kidney disease which can progress to a stage which requires kidney transplantation or dialysis. In people with diabetes, it has been reported that about 25-40% will develop diabetic kidney disease (DKD) over a 25-year period. People with DKD can have a higher risk of heart disease and stroke. With better management of blood glucose and blood pressure, the risk of developing DKD has reduced. Despite the availability of new medicines and good diabetes care, DKD is still the leading cause of dialysis in the community.

Author
Dr. Deepa

Thyroid nodules that are benign by FNAC or in ultrasound or too small to biopsy can always be followed up. Fortunately, more than 90% of thyroid nodules are not cancers. But still, a careful clinical examination by the endocrinologist and appropriate investigations is always advised. Physical examination and ultrasound may be recommended by the doctor every 6 to 12 months. Sometimes nodules can grow, sometimes shrink, or sometimes stay the same over time. Some changes in the nodules may not merit further investigations but some may. The treating endocrinologist may decide that some changes are suspicious and order a repeat FNAC or closer follow up.
Although rare, we sometimes see nodules which look benign become cancerous over time. So, it is important that you are in follow up with your endocrinologist at least on an annual basis.

Not all thyroid nodules need surgery. The factors which determine which if a person needs surgery are
a)Is the gland, or a portion of it, so large that it is stretching, compressing, or invading nearby structures in the neck? – in case of such nodules causing compressive symptoms surgery is advised.
b)Is the gland producing excess thyroid hormones? (hyperthyroidism)? Overactive thyroid nodules not amenable to other forms of treatment like medicines or radioactive iodine therapy may be considered for surgery.
c)Is the goiter or thyroid nodule due to malignancy? Fortunately, most patients with a goiter or thyroid nodule do not have thyroid cancer. By doing an ultrasound and fine needle aspiration cytology (FNAC), we can find out if a nodule has a high probability of being cancerous. All thyroid nodules that are found to contain thyroid cancer, or that are highly suspicious of a cancer, should be removed surgically by an experienced thyroid surgeon.
A careful examination of the patient, relevant blood investigations, an ultrasound and a fine needle aspiration cytology can help the endocrinologist decide to operate or just follow up the patient.

Many thyroid nodules do not have any symptoms. Some thyroid nodules may become big enough to interfere with swallowing or breathing. Some of them may cause changes in voice. Thyroid nodules are usually not painful. Having no symptoms, they are sometimes found when a scanning of the neck or chest is done for some other reason.
You may sometimes see a projection in your neck while trying to button up your collar, while shaving or even just by looking in the mirror. They tend to move when you swallow. The thyroid even without a nodule may feel a bit bumpy. Just by clinical examination, some nodules can be identified as cancerous by the endocrinologist. So, if you notice a swelling in your neck, it would be wise to meet an endocrinologist.

In general, 5-10 % of the nodules are malignant. There is a higher risk of thyroid cancer in a nodule when it is seen in people with certain risk factors:
1.It is more in women than in men.
2.It is more likely to be cancerous when it occurs in a child than in an adult.
3.Certain cancers like Medullary Cancer of thyroid can run in families.
4.Having a first degree relative with cancer increases the risk of cancer.
5.Being obese increases the risk of thyroid cancer.
6.The iodine status may change the type of cancer.
7.Having received radiation to the neck is a risk factor for thyroid cancer.
During the visit to an endocrinologist, it is important to discuss these risk factors if you have any. This will help in making better decisions in managing your thyroid nodule.

Nodules are abnormal growths in the thyroid. A few cells of the thyroid multiply abnormally and form a small lump in the substance of the thyroid. They may even have a cover (called capsule) which makes them separate from rest of the thyroid gland. A gland may have more than one nodule: it is then called multinodular goiter. Although more than 90 % of the nodules are benign, some of the nodules may be malignant (cancerous).
Some of these nodules are solid and some have fluid(cystic) and some are a mixture of both. Some are small and are not identified outside, but some may become big enough to obstruct breathing and swallowing. Some of them produce thyroid hormones and this can make the person hyperthyroid. Any growth of the thyroid is called a goiter.