For many people living with diabetes or high blood pressure, kidney disease does not arrive with a dramatic warning. It often slips in very silently. There may be no pain, no obvious symptoms, and no reason to suspect anything is wrong. That silence is exactly what makes kidney disease dangerous.
The kidneys work tirelessly, filtering waste, balancing minerals, and removing excess fluid from the body. However, diabetes and uncontrolled blood pressure can gradually damage these filters over time. According to the US National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), these two conditions remain the leading causes of chronic kidney disease worldwide. Studies supported by government agencies such as the National Institutes of Health have repeatedly highlighted that early detection and control of blood sugar and blood pressure can significantly slow kidney damage.
TOI spoke to Dr Reetesh Sharma, Chairman, Nephrology and Kidney Transplant, Yatharth Super Speciality Hospital, Sector 20, Faridabad. He explained, "Diabetes and high blood pressure also contribute to the development of kidney diseases. Kidney troubles can be asymptomatic until late into the disease process. This is why it is important for anyone with either of these diseases to monitor themselves for warning signs of kidney disease and have regular screening for kidney problems."
When Swollen Feet Are Trying to Tell You Something
Many people dismiss swelling around the ankles or puffiness around the eyes as a result of fatigue, too much salt, or ageing. But damaged kidneys lose their ability to remove excess fluid efficiently.
Dr Sharma explained, "One warning sign of kidney problems is swelling of the legs, ankles, feet, or face/eyes. Kidneys that are damaged are not as effective in removing excess fluid from the body through urination, and can cause fluid to build up in the body."
If socks start leaving deeper marks than usual, shoes suddenly feel tight, or morning facial puffiness becomes frequent, these changes deserve attention rather than neglect.
Changes in Urine Deserve More Attention Than They Usually Get
People rarely discuss urine patterns, but kidneys speak through them.
Dr Sharma said, "Another sign of kidney problems is changes in urine patterns, frequency of urination, increased urination or frequency at night, urine that is foamy, blood in the urine."
Foamy urine may indicate protein leakage, one of the earliest signs of kidney damage. Waking up several times at night to urinate, seeing blood in urine, or noticing unusual changes in colour or quantity should not be brushed aside.
The NIDDK notes that urine albumin tests and blood tests that estimate glomerular filtration rate (GFR) are among the most effective tools for identifying kidney disease early.
Constant Exhaustion Isn't Always Because of Work Stress
Modern life has made tiredness seem normal. But persistent fatigue that does not improve with rest may indicate that the kidneys are struggling to clear waste products from the blood.
Dr Sharma explained, "Persistent weakness and fatigue may also be a sign of a declining ability of the kidneys to do their job, as the kidneys filter toxins from the blood. Those who have kidney problems will feel exhausted and drained frequently and may also notice a decline in appetite, nausea, or unintentional weight loss."
A reduced appetite, unexplained weight loss, or feeling drained despite sleeping adequately should not automatically be blamed on a busy schedule. Many people discover kidney disease only after months of ignoring these subtle clues.
Dry and Itchy Skin May Have a Deeper Connection
Skin and kidneys are more connected than most people realise.
"Skin may also become dry and itchy, as kidney problems will affect the body's ability to regulate minerals and nutrients," said Dr Sharma.
Persistent itching without a clear allergy or extremely dry skin despite moisturisers may sometimes reflect changes happening internally.
Protecting the Kidneys Starts Long Before Symptoms Appear
Perhaps the biggest misconception about kidney disease is that symptoms must appear before action is needed. In reality, prevention begins much earlier.
Dr Sharma advised, "Individuals diagnosed with diabetes and high blood pressure are advised to perform regular self-checks for both their blood sugar levels and their blood pressure levels. More importantly, they should do routine testing, urine protein tests, kidney function tests, etc., to determine the status of their kidneys."
He added, "If kidney failure is caught early, it is possible to slow down or completely stop any additional damage to the kidneys. Being aware of the subtle signs and seeking timely medical attention can be very beneficial in protecting kidneys over a long-term period."
Experts recommend:
- Keeping blood pressure under control with medication and lifestyle measures.
- Maintaining healthy blood sugar levels and regular HbA1c checks.
- Avoiding smoking and excessive salt intake.
- Staying physically active.
- Drinking adequate water unless fluid restriction has been advised.
- Getting annual kidney function tests and urine protein tests, especially after years of diabetes or hypertension.
Medical Experts Consulted
This article includes expert inputs shared with TOI Health by Dr Reetesh Sharma, Chairman, Nephrology and Kidney Transplant, Yatharth Super Speciality Hospital, Sector 20, Faridabad. Inputs were used to highlight the often-overlooked early signs of kidney disease in people living with diabetes and high blood pressure, and to explain why regular monitoring and timely screening can help detect damage early and protect long-term kidney health.
