PART 1 Scenario:
Mr. A comes to a pharmacy with his mother’s health check report.
| Pharmacist :
Mr. A :
Pharmacist : Mr. A :
|
Hello Sir, what can I help you with?
Few days ago, my mom had very serious swelling on her legs. So I brought her to hospital for check-up and the doctor says she has end-stage kidney failure. My whole family is quite shocked by this news as my mom had no signs or symptoms before. May I know if she has any other health problems? She has hypertension and diabetes for 20 years but she’s taking medicines and the her readings are considered OK. Umm…..Blood pressure is around 140/90 mmHg and the fasting glucose level is 7-8 mmol/L.
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How HYPERTENSION and DIABETES
lead to Chronic Kidney Disease?
Kidneys act like your household water filtering system. Under normal circumstances, they only allow waste product like excess water and ion to pass through the filter sheet. Substances such as protein, red blood cell and glucose will not be filtered out due to larger molecular size.
Fig. 1: Progression of CKD severity influenced by prolonged High Blood Pressure in long term
However, under persistent high pressure, those proteins and red blood cells will be forced through the filter sheet, creating larger pores. Over time, the filter sheet will be damaged and unable to perform usual filtering function well.
Fig. 2: Progression of CKD severity influenced by prolonged High Blood Glucose in long term
In diabetic patients, the blood sugar level is always high. Therefore, the glucose tends to bind together to form a sharp edged crystal. Those crystal will cut through the filtering layer, resulting in larger pores. Kidneys are then unable to filter properly due to larger pores in filter layer, and thus leading to kidney failure.
Gentle reminder:
- Keep blood pressure within normal range (≤ 130/85mmHg) to reduce the damage of kidney by high blood pressure.
- Monitor blood glucose and HbA1C (average blood sugar control in past 3 months) regularly. Target HbA1C ≤7% can greatly reduce risk of developing kidney disease.
Note: Kindly refer to your healthcare professional for further information.
References:
- Malaysia National Kidney Foundation
- U.S. National Kidney Foundation
- UK NHS Kidney Care
- MALAYSIA CKD CPG 2011