106. Save Your Kidneys
How can diabetic kidney disease be prevented ?
Important tips to prevent diabetic kidney disease include:
- Follow up regularly with the doctor.
- Achieve the best control of blood sugar. Keep HbA1C levels less than 7%.
- Keep blood pressure below 130/80 mmHg. Antihypertensive drugs called angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) should be used to control hypertension and aid in the reduction of albuminuria.
- Restrict sugar and salt intake and eat a diet low in protein, cholesterol and fat.
- Check kidneys at least once a year by performing a urine test for albumin and blood test for creatinine (and eGFR).
- Other measures: Exercise regularly and maintain ideal weight. Avoid alcohol, smoking, tobacco products and indiscriminate use of painkillers.
Urine dipstick test to diagnose macroalbuminuria is the most feasible diagnostic option for developing countries.
Treatment of diabetic kidney disease
- Ensure proper control of diabetes.
- Meticulous control of blood pressure is the most important measure to protect the kidneys. Blood pressure should be measured regularly and maintained below 130/80 mmHg. Treatment of hypertension slows the progression of chronic kidney disease.
- Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are antihypertensive drugs that have a special advantage for diabetic patients. These antihypertensive drugs have the additional benefit of slowing the progression of kidney disease. For maximum benefit and kidney protection, these drugs are administered at the earliest stage of diabetic kidney disease when microalbuminuria is present.
- To reduce facial or leg swelling, drugs which increase urine volume (diuretics) are given along with restriction of salt and fluid intake.
- Patients with kidney failure due to diabetic kidney disease are prone to hypoglycemia and therefore need modification in drug therapies for diabetes. Short acting insulin is preferred to control diabetes. Avoid long acting oral hypoglycemic agents. Metformin is usually avoided in patients with serum creatinine levels more than 1.5 mg/dl due to the risk of lactic acidosis.
- In diabetic kidney disease with high serum creatinine, all measures of treatment of chronic kidney disease (discussed in Chapter 12) should be followed.
- Evaluate and manage cardiovascular risk factors aggressively (smoking, raised lipids, high blood glucose and high blood pressure).
- Diabetic kidney disease with advanced renal failure requires dialysis or kidney transplant.
Maintain blood pressure less than 130/80 by using ACE inhibitors and ARBs as initial antihypertensive drugs early in the disease.
108. Save Your Kidneys
When should a patient with diabetic kidney disease consult a doctor?
Diabetic patients with microalbuminuria should be referred to a kidney specialist. The patient with diabetic kidney disease should immediately consult a doctor in case of:
- Rapid unexplained weight gain, marked reduction in urine volume, worsening of facial and leg swelling or difficulty in breathing.
- Chest pain, worsening of pre-existing high blood pressure or very slow or fast heart rate.
- Severe weakness, loss of appetite or vomiting or paleness.
- Persistent fever, chills, pain or burning during urination, foul-smelling urine or blood in urine.
- Frequent hypoglycemia (low sugar level) or decreased requirement of insulin or anti-diabetic medications.
- Development of confusion, drowsiness or convulsion.
Meticulous attention to cardiovascular risk factors is an essential part in the management of diabetic kidney disease.