By SeeFoon Chan-Koppen
Ipoh Echo recently talked to Dr Fauziah Khairuddin, Consultant Nephrologist at KPJ Ipoh Specialist Hospital about prevention of chronic kidney disease (CKD). For the layperson, a nephrologist is a Physician who has been trained in the management of kidney disease which may include inflammation, infection, kidney stone disease, acute and chronic kidney injury. They also manage end stage renal failure patients i.e., the ones on dialysis.
Dr Fauziah is a sessional Nephrologist with 3 clinics a week and has been practising at KPJ for the past 24 years. According to Dr Fauziah, diabetes mellitus accounted for more than half of the primary renal disease in new dialysis patients for the last 10 years .
In general, the presence of the following risk factors for CKD should provoke formal testing for CKD. These include history of diabetes mellitus, cardiovascular disease, hypertension, hyperlipidemia, obesity, metabolic syndrome, smoking, human immunodeficiency virus (HIV) or hepatitis C virus infection, and malignancy; family history of kidney disease or treatment with potentially nephrotoxic (kidney toxic) drugs
Long standing diabetes mellitus especially if poorly controlled will lead to diabetic nephropathy whose risk factors include having chronically elevated blood sugar levels, being overweight or obese; smoking; having a diabetes-related vision problem (diabetic retinopathy) or nerve damage (diabetic neuropathy).
To diagnose, urine tests are recommended once per year in people with type 1 diabetes, beginning about five years after diagnosis, and in people with type 2 diabetes, starting at the time of diagnosis.
DIABETIC NEPHROPATHY TREATMENT
People with diabetes often focus on keeping their blood sugar levels in the right ranges. And while it is important to control blood sugar, it turns out that controlling blood pressure is at least as important. That’s because high blood sugar and high blood pressure work in concert to damage the blood vessels and organ systems.
For these reasons, the most important things you can do to stall kidney disease and protect against other diabetes complications are to make healthy lifestyle choices, keep your blood sugar as close to normal as possible, keep your blood pressure below 140/90, if possible.
Lifestyle changes include limiting the amount of salt you eat; quitting smoking; losing weight if you’re overweight.
Manage blood sugar levels by keeping blood sugar levels close to normal can help prevent the long-term complications of diabetes mellitus. For most people, a target for fasting blood glucose and for blood glucose levels before each meal is (4.4 to 6.6 mmol/L).
A blood test called A1C is also used to monitor blood sugar levels; the result provides an average of blood sugar levels over the last one to three months. Even small decreases in the A1C lower the risk of diabetes-related complications to some degree.
Manage high blood pressure — Many people with diabetes have hypertension (high blood pressure). Although high blood pressure causes few symptoms, it has two negative effects: it stresses the cardiovascular system and speeds the development of diabetic complications of the kidney and eye.
If these measures are not effective or your blood pressure needs to be lowered quickly, your provider will likely recommend one of several high blood pressure medications.
Blood pressure medications — Most people with diabetic nephropathy need at least one medication to lower their blood pressure.
Monitor for signs of change — After beginning treatment and lifestyle changes to stall kidney disease, you will need to have repeat urine and blood tests to determine if urine protein levels have improved.
So to prevent kidney disease, lead a healthy lifestyle, eat a balanced diet, quit smoking, maintain a normal weight and if you have diabetes mellitus or high blood pressure, do follow up regularly with your doctor and check for kidney involvement as has been outlined above. Those with a family history of kidney disease such as polycystic kidneys should also go for a screening test for kidney disease.
Dr Fauziah Khairuddin, Consultant Nephrologist. KPJ Ipoh Specialist Hospital Tel: 05 240 8777.