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Kidney Disease
Established diagnosis of kidney disease:
Referral to a Nephrologist is necessary to optimize renal function by treatment, to reduce morbidity, and to reduce risk of mortality.
Conditions which may cause chronic kidney disease:
Diabetes and kidney disease (Diabetic nephropathy):
Diabetes mellitus is the most common cause of kidney disease. Taking lifestyle measures to prevent, control or reverse diabetes by strictly controlling blood glucose will, in turn, prevent kidney disease or reduce progression of kidney disease. See the diabetes mellitus section in Preventive Health Advisor.
The earliest sign of kidney disease in diabetics is the presence of microalbuminuria (protein seen in the urine). The American Diabetic Association recommends to provide annual screening to all type 2 diabetes mellitus patients for microalbuminuria starting at the time of diagnosis and for type 1 diabetes mellitus, starting 5 years after diagnosis (4). Compliance to this recommendation was reported to be suboptimal at times among primary care physicians, but electronic medical records and quality control has improved adherence (5). Patients should be educated about this necessity to reinforce their own self compliance. Taking lifestyle measures to treat diabetes by strictly controlling blood glucose will, in turn, reduce diabetic nephropathy rate of progression. Medications called angiotensin-converting enzyme inhibitors (ACE inhibitors) and angiotensin II receptor blockers (ARB’s) may prevent or in some cases, reverse rate of kidney disease progression (6). These medications reduce proteinuria.
