Protecting Your Kidneys When You Have Diabetes or High Blood Pressure

Diabetes and high blood pressure are the two commonest reasons people in India end up on dialysis. They are also the two most preventable. The damage is silent for years, which is exactly why it is worth looking for early.

The one test most people are missing

A urine albumin-to-creatinine ratio, once a year, from a single sample. A normal serum creatinine does not rule out early diabetic kidney disease — protein leak usually comes first. If you have type 2 diabetes, screening should start at diagnosis; in type 1, about five years after.

What we do when the screen is abnormal

• Confirm it on a repeat sample, because fever, exercise and infection can all raise it temporarily
• Treat blood pressure to an individualised target, measured properly
• Start an ACE inhibitor or ARB at the dose you tolerate
• Add an SGLT2 inhibitor, which protects both kidney and heart
• Consider a non-steroidal mineralocorticoid receptor antagonist (finerenone) where protein leak persists despite the above
• Review glucose-lowering therapy with your diabetes doctor rather than around them

Working with your diabetes doctor, not instead of them

I do not take over your diabetes care. I look after the kidney side and send a written note back to your treating physician after every visit.

When to refer or come in

Rising ACR, falling eGFR, blood pressure needing three or more drugs, or an unexplained drop in kidney function after starting a new medicine.