Kidney Damage

Detection and surveillance

Detection and surveillance of kidney problems and blood pressure are a routine part of Annual Review

Check for proteinuria yearly using reagent strips

Measure urinary albumin excretion yearly ( if not proteinuric ) using :

pre-breakfast albumin:creatinine ratio, or

pre-breakfast urinary albumin concentration

if ratio >2.5 mg/mmol ( >30 mg/g ) in men or >3.5 mg/mmol ( >40 mg/g ) in women or concentration >20 mg/l :

Check for infection and consider other renal disease if proteinuria positive

exclude infection with leucocyte strips and mid-stream urine microscopy / culture

Measure serum creatinine yearly ( more often if abnormal )

Measure blood pressure yearly for surveillance purposes ( sitting, 1st/5th sounds, 5 min rest )

Blood pressure management if raised albumin excretion rate

Treat aggressively with a target of <130/80 mmHg or lower if easily attained
		stop smoking
		reduce salt intake
		reduce protein intake with target of <0.8 g/kg
		use ACE inhibitors as first-line drug therapy
		add loop diuretics, a-blockers, other agents if necessary
		avoid the combination of ß-blockers and thiazides if dyslipidaemia

Other management

Maintain good blood glucose control and tight arterial risk factor control ( see above )

Treat urinary infections aggressively; consider papillary necrosis if recurrent

Arrange early evaluation by a nephrologist ( at creatinine <200-300 µmol/l ( <2.5-3.5 mg/dl ) )

No patient should be excluded from renal replacement programmes solely on the basis of having diabetes