Dr. Mammen M. John, Dr. George Kurian, Dr. Mohammed Iqbal, Dr. Rajesh R.
Diabetic Nephropathy is now a major cause of End Stage Renal disease. Nephropathy occurs in 30-40% of diabetic patients. It can occur in clusters in certain families. There is a genetic predisposition. If Nephropathy does not develop in 15 years after the onset of Diabetes then it is unlikely to occur. Early diagnosis is based on the detection of urinary albumin excretion. Various tests are available to detect this. Radioimmuno assay is a sensitive test. Urinary microalbuminuria is the early finding and the treatment has to be started as early as possible to prevent over albuminuria and renal failure. Control of Blood sugar and Blood pressure are very important. The drugs shown to be effective in reducing protienuria are angiotensin converting enzyme inhibitors and angiotensin receptor blockets. These drugs have to be started with caution, after checking renal parameters and potassium. Renal functions have to be rechecked again few days after starting these drugs and then periodically. In the event of mild to moderate renal failure these drugs can still be used, again with extra caution. In certain patients diabetic nephropathy can progress to end stage renal disease over a period of time. It is important that this group is identified earlier and appropriate measures are instituted and they are prepared for renal replacement therapy. Haemodialysis, Peritoneal dialysis and renal transplantation are options that can be considered for patients reaching end stage renal disease.