DIABETICS with eight to 10 years of disease are at a greater risk of developing kidney disease than others. The risk increases further with the passage of time. However, someone who has not developed diabetic kidney disease even after 25 years of diabetes, he is then unlikely to suffer from it. Still, vital signs to watch out include:
FAMILY HISTORY: Diabe-tics whose parents have diabetic kidney disease.
GLYCAEMIC CONTROL: There is conclusive evidence that good control of diabetes substantially reduces the risk of developing diabetic kidney disease. Those with poorly controlled diabetes are at a higher risk.
BP CONTROL: Uncontrolled blood pressure is, also well documented as, a risk factor. Type 1 diabetics usually develop high-blood pressure when they develop diabetic kidney disease. Whereas a substantial number of type 2 diabetics have high blood pressure before any manifestation of diabetic kidney disease.
DYSLIPIDAEMIA: Abnorm-ally high cholesterol level in the blood can cause, as well as aggravate kidney damage in a diabetic.
TOBACCO: Smoking incre-ases the risk of kidney damage in diabetics. Diabetic kidney disease deteriorates rapidly in heavy smokers compared to non-smokers.
SCREENING FOR DIABETIC NEPHROPATHY: It is absolutely necessary for every diabetic to be screened for diabetic kidney disease. The individual should not have any acute illness or infection particularly urinary tract infection at this time. The first test is Urine analysis of an early morning specimen. If it is negative for proteins than urine should be checked for microalbumin. If microalbumin is negative, then an annual screening is enough. If microalbumin is present, the test should be repeated. To confirm kidney involvement at least two out of three samples should be positive for microalbumin. If urine DR is positive for protein then some more blood and urine tests are recommended. Serum creatinine levels should be done at least annually.
PREVENTIVE MEASURES: Blood pressure should be checked regularly. Periodic blood sugar monitoring, some large clinical trials, on thousands of patients for several years, have convincingly shown that strict control of blood sugar decreases the incidence of diabetic kidney disease. However, there is no effect, once the complication sets in. Strict diabetes control is defined as a fasting blood sugar less than 110 mg/dl, random blood sugar less than 144 mg/dl and glycated haemoglobin (a blood test that relates to mean blood sugar level over previous 12 weeks) less than 7.0 per cent. Similarly, there is sufficient clinical data, which shows that good blood pressure control (around 125/75mm of Hg) retards the progression of diabetic kidney disease. Some blood pressure lowering drugs are superior to others in achieving this. Like all medication, these drugs should only be taken under the supervision of a doctor. Abnormal level of fats in the blood must be corrected by appropriate changes in the diet; physical exercise and if required drugs.
The threat of diabetic pandemic is real. The future may witness an enormous increase in the number of cases of diabetic kidney disease including kidney failure. We have to handle this challenge now, as otherwise serious consequences are bound to manifest. These would be in terms of increased health care expenditure, physical and emotional suffering, poor quality of life and decreased productivity of a sizable proportion of our population.
