Breathlessness at rest, chest pain or confusion needs emergency care now. Also seek urgent care for a foot ulcer with fever or spreading redness, which can progress rapidly in diabetes.
The commonest cause of kidney failure worldwide. Damage develops silently over years, and by the time symptoms appear a great deal of function has already gone — but the decline can be slowed substantially.
If you have diabetes and protein in your urine, this page is about buying you years. The medication now available for this is considerably better than it was a decade ago and is frequently not prescribed.
Persistently high blood glucose damages the tiny filtering units of the kidney over years. The earliest detectable sign is small amounts of protein leaking into the urine, long before the creatinine begins to rise or any symptom appears.
The progression is usually predictable — increasing protein loss, then rising blood pressure, then a gradual fall in filtration rate over years. That predictability is an opportunity: intervening early alters the trajectory substantially.
What has changed the picture is medication. Blood pressure drugs that block the renin-angiotensin system have long been standard. More recently, SGLT2 inhibitors have been shown to slow the decline in kidney function meaningfully in diabetic kidney disease, and they also reduce heart failure. They are frequently not prescribed to patients who would benefit.
The other thing to understand is that most people with diabetic kidney disease die of heart disease rather than reaching dialysis. Cardiovascular risk management — blood pressure, cholesterol, stopping smoking — is not a side issue but a central part of treating the kidneys.
These medications, originally developed for glucose control, have been shown to slow the decline of kidney function in diabetic kidney disease and to reduce heart failure and cardiovascular death. They are recommended in current guidelines for most patients with diabetic kidney disease and protein in the urine, and yet a great many eligible patients are not taking one. Alongside a blood pressure drug that blocks the renin-angiotensin system, this combination is the most effective thing available for preserving your remaining kidney function. It is worth asking your doctor about specifically.
Simple tests, done regularly, detect this years before symptoms.
A single creatinine tells us where you are; a series over months or years tells us where you are going, and the rate of decline determines how long you have before dialysis or transplant. Send them with dates, along with your urine albumin ratio, HbA1c, blood pressure readings and your current medication list. Whether you are on the right drugs is the first thing we will look at.
Slowing the decline is the treatment, and it works better than most patients are told.
A blood pressure drug blocking the renin-angiotensin system, plus an SGLT2 inhibitor where eligible, and in selected patients a non-steroidal mineralocorticoid receptor antagonist. This combination slows the loss of kidney function meaningfully and reduces cardiovascular events. It is inexpensive relative to dialysis and widely available.
Tight blood pressure control is the single most effective measure. Good glucose control slows progression, particularly early. Statins reduce the cardiovascular risk that is more likely to kill you than the kidney disease. Stopping smoking matters as much as any drug.
Diabetic patients are transplanted successfully and routinely, and it remains far better than dialysis for them. The important difference is that cardiac assessment before transplant must be thorough, because coronary disease is common and frequently silent in diabetes. Diabetes control after transplant also needs attention, since steroids raise glucose.
Where transplant is not possible, dialysis sustains life. Diabetic patients on dialysis need particular attention to foot care, vascular access, blood pressure during sessions and glucose control, all of which are more difficult than in non-diabetic patients.
This is the first question and frequently the answer. Many patients are missing drugs that would slow their decline substantially.
The trend in eGFR over time predicts when dialysis or transplant will be needed and sets the planning timeline.
Coronary disease is common and often silent in diabetes. Thorough cardiac assessment is essential before transplant and is where Dr. Varughese's involvement genuinely matters.
Before any transplant discussion we will look at whether your medication is optimised. Adding the right drugs can delay dialysis by years, and it costs a fraction of a transplant.
Chest symptoms in a diabetic patient with kidney disease need urgent local assessment. Coronary disease is common, frequently silent, and the leading cause of death in this group.
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Established scarring cannot be reversed, but the rate of decline can be slowed substantially — often by years. Kidney-protective medication, tight blood pressure control, good glucose control and stopping smoking together make a considerable difference. The earlier this starts, the more function is preserved.
A class of tablet originally developed for glucose control that has been shown to slow the loss of kidney function in diabetic kidney disease and to reduce heart failure. Current guidelines recommend it for most patients with diabetic kidney disease and protein in the urine, yet many eligible patients are not on one. It is worth asking your doctor directly.
Because albumin in the urine is the earliest sign of kidney damage in diabetes, appearing years before creatinine rises or any symptom develops. It is a cheap annual test that identifies the problem at the stage when treatment does the most good. Everyone with diabetes should have it checked yearly.
Yes, routinely, and it remains far better than dialysis. The important difference is that cardiac assessment beforehand must be thorough, because coronary disease is common in diabetes and frequently causes no symptoms. Glucose control after transplant also needs attention, since the steroids used raise blood sugar.
Not necessarily. As kidney function declines, insulin is cleared more slowly and requirements fall, which can look like improving diabetes but may signal worsening kidney function. If your insulin needs have dropped without a change in diet or weight, have your kidney function checked.
Because most people with diabetic kidney disease are more likely to be harmed by heart disease than to reach dialysis, and coronary disease in diabetes is frequently silent. Treating cardiovascular risk is part of treating the kidneys, not a separate matter, and cardiac fitness determines whether transplant is safe.
Send several creatinine results with dates so we can see the trend, plus your urine albumin ratio and full medication list. Whether you are on the right drugs is the first thing we check.
Your reports go directly to our medical team. We do not share your records with hospitals until you tell us to.
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