Diabetes Effects Of Diabetes On Kidney Kidneys are major target organs of long standing Diabetes, being affected in upto 40 % of patients. Although it takes several years before nephropathy (kidney disease) sets in, the time period is extremely variable and depends primarily on the severity of diabetes and degree of control. As the incidence of diabetes is rapidly increasing (estimated to be around 8-10 % of the population, (more in urban areas), diabetic kidney has become somewhat like an epidemic that has unfortunately not been recognized outside the nephrology community. What are the early signs and symptoms?
 Truly speaking symptoms occur late in the disease course. Early involvement can only be detected by the presence of Microalbuminuria, a specialised test that detects the presence of minute quantities of Albumin (hence the name) in urine. Left untreated there is a progressive rise in the quantity of albumin passed in urine along with physical manifestations of swelling of feet and onset of hypertension. After a while kidney function begins to worsen which can diagonised by rising levels of serum Creatinine. Eventually there is progressive renal failure with frank uremia (nausea, vomitting, loss of appetite) and fluid retention causing respiratory distress. What can be done to prevent diabetic kidney disease?
Prevention of diabetic kidney disease can be achieved by tight control of diabetes. It is important that every diabetic. Individual be aware of the treatment goals and target levels of blood glucose (Fasting glucose < 110 mg%, post prandial glucose < 160 mg%). Those who also have hypertension should try lifestyle modification and adjust antihypertensive medication to achieve blood pressure below 130 / 80 mmHg.
Microalbuminuria must be tested prospectively in all diabetics. If found positive ACE inhibitors or ARB group of drugs are prescribed which are very effective in reducing albumin leakage. Blood biochemistry particularly serum Potassium and Creatinine are closely monitored after introduction of these agents. Microalbuminuria is also a predictor of heart disease and relevant investigations are therefore warranted. Depending on other system involvement and degree of control switching to insulin is often considered. What can be done to treat established kidney disease?
 Unfortunately the large majority of cases are diagnosed when kidney disease is already advanced. The principal strategy in this stage also is to keep Hypertension and Diabetes very tightly controlled. Statins are used to keep LDL Cholesterol values lower than 80mg%. Anemia vitamins are Erythropoeitin injections. Once established, there is always a possibility of progressive loss of kidney function. Intensive target oriented treatment in recent times have made it possible to slow down the rate of deterioration significantly. Beyond a certain limit however medications are no longer effective and Renal Replacement by means of Dialysis or Kidney transplantation becomes mandatory. Renal Replacement Therapy
 Transplantation is the first choice even in diabetics as the survival and quality of life is much better than that on dialysis. Significant coexisting heart disease needs to be excluded and if present adequately treated before transplantation. Of course transplantation is generally done in relatively younger patients who are otherwise fit. Hospital based Hemodialysis and home-based Peritoneal dialysis are options of dialytic therapy. Other than medical factors logistics of care determine the choice of modality. In recent times the results of transplantation have improved immensely and with newer technology survival on dialysis is getting better with each passing year. Unfortunately the cost of renal replacement remains fairly high. Prevention of kidney disease should therefore be the principal goal. ********************************************* Effects Of Diabetes: Lungs | 
