A survey by the Chinese Diabetes Association found that the prevalence of diabetes in China is 9.7%, and it is estimated that there are nearly 100 million people with diabetes in China, which has surpassed India as the world’s number one country for diabetes. Diabetic kidney damage is one of the most dangerous complications for diabetics. In Europe and the United States, diabetes has become the most important cause of chronic kidney disease and end-stage renal disease, accounting for more than 50% of the primary causes of end-stage renal disease patients. In China, kidney disease caused by diabetes is also gradually becoming the main cause of end-stage renal disease, second only to primary glomerulonephritis and hypertension. Therefore, it is high time to control blood sugar and prevent diabetic kidney damage. Normal kidneys filter a large amount of metabolic waste from the blood every day to maintain the balance of the body’s internal environment. In diabetic patients, if the blood sugar is not well controlled, resulting in high concentration of glucose in the blood, the kidneys are forced to work overload to filter too much glucose in the blood. Eventually, the kidneys that are continuously working under high load cannot do a good job of filtering glucose, or even stop working. In this way, diabetic kidney damage is difficult to avoid. Diabetes – How does it affect the kidneys? The kidneys consist of millions of kidney units made up of capillary collaterals that act as blood filters. As blood flows through these capillary collaterals, metabolic waste products are excreted through the vessel walls and eventually into the urine. When blood glucose is poorly controlled in diabetic patients, high blood glucose levels cause the kidneys to work overtime to increase the filtration of glucose. As a result, the permeability of the capillary collaterals increases and leakage begins to occur, and proteins that would not normally pass through the capillary walls leak into the urine, forming proteinuria. If the blood glucose is not well controlled before the appearance of proteinuria, the diabetic kidney damage continues to progress and the kidneys are unable to remove the toxic metabolites produced by metabolism in the blood, resulting in a gradual increase in blood creatinine and urea nitrogen, which eventually leads to kidney failure. However, having diabetes does not necessarily mean that diabetic kidney damage or kidney failure occurs. With good long-term control of blood glucose, the risk of developing diabetic kidney complications is significantly reduced, and many patients do not develop diabetic kidney damage for life. Diabetes – Kidney damage due to elevated blood pressure Patients with diabetes are prone to elevated blood pressure or hypertension due to vasculopathy caused by elevated blood sugar. Elevated blood pressure is also one of the serious complications of diabetes and can lead to heart pump dysfunction and systemic vascular damage. If the kidneys are involved, they are unable to effectively remove metabolic waste and excess fluid from the body. The excess fluid is retained in the blood vessels, leading to a further increase in blood pressure, which further aggravates the kidney damage, creating a vicious cycle. If both diabetes and hypertension are present, the risk of kidney damage is significantly increased. At this point, managing blood pressure through measures such as quitting smoking, reducing salt intake and regular physical activity is extremely important to prevent the development of kidney damage. Diabetes-Renal Damage Prevention Once diabetes is diagnosed, vigilance for the risk of diabetic kidney damage should begin. Therefore, diabetic patients should visit endocrinology and nephrology departments regularly to follow up blood glucose changes and check urinary microalbumin excretion rate at least 2-3 times a year. Once urine microalbumin is elevated, it marks the appearance of kidney damage and the beginning of protein leakage. If it is accompanied by an elevated blood creatinine level, it indicates the presence of metabolite elimination disorders in the kidneys. Effective control of blood glucose levels is necessary to effectively prevent the development of diabetic kidney damage. Measures to control blood glucose include a detailed and specific diet plan, appropriate regular physical exercise, insulin and other medications, and regular blood glucose monitoring. In addition, kidney and or urinary tract infections are also important factors in kidney damage in diabetic patients. Therefore, the symptoms of urinary tract irritation, back pain, cloudy urine, hematuria, fever, chills and other manifestations should be promptly sought medical attention. Treatment of diabetes – kidney damage Diabetic patients who already have signs of kidney damage should reduce the burden on the kidneys and delay the progression of kidney disease through medications based on diet and blood sugar control.1. The main drugs that have been recognized to delay kidney damage include angiotensin converting enzyme inhibitors (ACEI) and angiotensin.2. receptor antagonists (ARB). These 2 types of drugs are not only effective in reducing proteinuria and delaying the progression of renal impairment, but also in significantly controlling hypertension. In addition, herbal medicines such as Astragalus and Astragalus also have significant therapeutic effects on the progression of renal damage. Some drugs with obvious nephrotoxicity should be avoided when diabetic kidney damage is present. Such as antipyretic and analgesic drugs, a variety of anti-infective drugs and contrast agents, in the presence of diabetes, often lead to the progression of renal damage, and should be avoided or used in small doses for short courses as much as possible. When diabetic kidney damage enters the end stage, renal replacement therapy such as peritoneal dialysis, hemodialysis or kidney transplantation can only be chosen according to the patient’s general condition and economic conditions.