Diabetic kidney disease
Diabetic nephropathy is a major complication of diabetes and is the number one cause of end-stage kidney disease in New Zealand.
Dr Grace Lee, Deputy Director of Goodfellow Unit, talks with Dr Hari Talreja about diabetic kidney disease. Hari is an American Society of Hypertension certified Specialist and Renal Physician with training and experience from Canada, and a Masters Degree from Harvard University.
He is currently a Consultant Renal Physician at Counties Manukau and Ormiston Specialist Centre.
Topics include:
- Diabetic kidney disease in New Zealand.
- Full renal assessment.
- Managing microalbuminuria.
- Avoiding overuse of NSAIDS and other nephrotoxic drugs.
Resources
Audit tools
- Clinical record review self-audit checklist RNZCGP (2018)
- Primary Care Ethnicity Data Audit Toolkit NZ MOH (2013)
- Improving safety for patients taking an ACE inhibitors/ARBs + diuretic bpacnz (2018)
General resources
- Kidneyfailurerisk.com
- The triple whammy - safe prescribing - a dangerous trio SaferX (2017)
- Prescribing ACE inhibitors: time to reconsider old habits BPAC (2018)
- Microalbuminuria: control the diabetes and BP and use care with NSAIDs Goodfellow Gem (2019)
- Slowing progression of renal dysfunction in patients with diabetes bpacnz (2019)
References:
- Kenealy et al. Increased prevalence of albuminuria among non-European peoples with type 2 diabetes. Nephrol Dial Transplant (2012) 27: 1840–1846.
- ANZDATA Registry. 41st Report, Chapter 9: End Stage Kidney Disease in Aotearoa New Zealand. Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia. 2018. Available at: http://www.anzdata.org.au
- Gaede et al. Intensified multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria: the Steno type 2 randomised study. Lancet. 1999; 353(9153):617.
- Hypertension in Diabetes Study (HDS): I. Prevalence of hypertension in newly presenting type 2 diabetic patients and the association with risk factors for cardiovascular and diabetic complications. J Hypertens. 1993;11(3):309.
- Schrier et al. Effects of aggressive blood pressure control in normotensive type 2 diabetic patients on albuminuria, retinopathy and strokes. Kidney Int. 2002;61(3):1086.
Peer group discussion points |
As noted, Māori and Pacific people are at greater risk of diabteic nephropathy.
A full diabetic renal assessment takes into account risk factors, blood pressure, renal testing (ACR, creatinine and eGFR), alongside assessing for the risk of progression. Within this assessment, microalbuminuria is an important screening tool for assessing end organ damage due to diabetes.
Patients with diabetic renal disease are often on multiple medications which can have a deleterious effect on renal function. The term “Triple Whammy” has been used to describe group of medications ( ACEi/ARB, a diuretic and a NSAID) that individually or combined can cause acute renal injury.
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