What tests should be done to prevent diabetes and kidney disease?

To prevent diabetic nephropathy, the first two tests that people with diabetes should pay attention to are the urine microalbumin/creatinine ratio (ACR) and the estimated glomerular filtration rate (eGFR). This is the gold standard for early screening recognized by global guidelines. It is much more sensitive than ordinary urine routine and blood creatinine alone, and can catch the signal when kidney damage has just begun.

A while ago, I treated a 47-year-old Zhou, who has been suffering from type 2 diabetes for 7 years. His fasting blood sugar is basically stable at around 6mmol/L. Every year, he does a urine routine for physical examination at the workplace. He has never seen positive urine protein, so he always thought that his kidneys were fine. Last month, his ankle suddenly swelled, and even when he put on his socks, there was a lump. It took two or three days for the symptoms to go away before I came to see a doctor. I found out that the ACR had reached 280 mg/g, indicating that I had reached stage 3 of diabetic nephropathy. If ACR had been included in the annual screening two or three years earlier, I could have intervened when microalbuminuria first appeared, and the probability of reversal would have been much higher than now.

When it comes to screening frequency, there are currently two different recommendations in the industry: mainstream endocrinology guidelines believe that type 1 diabetes should be checked for the first time after five years after diagnosis, and type 2 diabetes should be checked for the first time when it is first diagnosed. After that, at least once a year is enough.； Some scholars specializing in nephrology have also suggested that if a diabetic patient also has high blood pressure, hyperlipidemia, a family history of chronic kidney disease, or blood sugar fluctuations are particularly large, it is best to increase the frequency of screening to once every six months to catch abnormal signals in a more timely manner.

These two tests are actually very convenient. ACR only requires random urine collection. There is no need to hold back morning urine or save 24 hours of urine. A tube of blood can be drawn to measure creatinine and calculate eGFR at the same time. It can be done in one outpatient visit and does not cost much. Many people with diabetes are accustomed to only looking at the blood creatinine value, thinking that if the creatinine is normal, the kidneys will be fine. In fact, this is a big misunderstanding - blood creatinine is like a smoke alarm at home. It will only sound when there is smoke in the house. The kidneys themselves have strong compensatory capabilities. Blood creatinine will only increase when the damage exceeds 50%, and eGFR is calculated by combining your age, gender, and blood creatinine value. It is equivalent to installing a temperature sensor in the kitchen. The alarm can be triggered as soon as a fire breaks out, and the sensitivity is much higher.

Don’t panic if your ACR is found to be elevated for the first time. It’s not necessarily due to diabetes. After all, strenuous exercise, fever, and urinary tract infection may cause a temporary increase. The doctor will usually ask you to recheck twice within 3 months. If two of the three times are above the normal range, further intervention is required. If there are indeed problems during the re-examination, a fundus screening will usually be performed. After all, diabetic nephropathy and diabetic retinopathy are both microvascular complications, and most of the time they progress simultaneously. The fundus results can also help doctors determine whether it is really diabetes kidney disease or combined with other types of kidney disease.

Next time you go for an endocrinology follow-up consultation, you can take the initiative to mention that you want to check these two items. After all, early screening is always more effective than late treatment in preventing diabetes kidney disease.