Diabetic kidney disease in primary care

Abstract

Mdm Chee, a 55-year-old homemaker, visited your clinic for a routine follow-up for her chronic conditions. She shared that she is careful about what she cooks to keep her Type 2 diabetes mellitus, hypertension and hyperlipidaemia controlled. You were happy to note her compliance to medications (metformin 850 mg three times daily, glipizide 10 mg twice daily and amlodipine 10 mg every morning). Her blood pressure was 140/90 mmHg, and her home blood pressure diary revealed similar readings over the past few months. Laboratory results showed a glycated haemogloblin level of 8.0%, serum creatinine of 112 µmol/L (estimated glomerular filtration rate 48 mL/min/1.73 m2) and urine albumin/creatinine ratio of 40 mg/mmol; four months ago, they were 7.8%, 106 µmol/L (51 mL/min/1.73 m2) and 30 mg/mmol respectively. She would soon undergo panretinal photocoagulation on her right eye, but she was scared because the ophthalmologist had said that diabetes mellitus may lead to kidney failure. She asked if there was anything you could do to help her avoid needing dialysis.