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How can I prevent kidney damage associated with diabetes?

Q: I am male, 66 years old, height is 163 cms and weight 87 kg. My left kidney was removed two years back due to renal cell carcinoma. I have diabetes and hypertension. My HbA1c is 8.1 and BP is 130/80. I have been diabetic for the last 12 years, and taking insulin 20 units - morning, noon and at night. I am also taking Glucobay, Amaryl, Losar and a multivitamin. My 24 hours urine report is as follows - total urine volume: 1600 ml/day, protein excretion: 441 mg/day, creatinine excretion: 1 g/day, creatinine clearance: 44 ml/mits and serum creatinine: 1.5 mg/dl. Please advise.

A:You seem to be having the beginning of diabetic nephropathy. You must have microalbuminuria tested in your urine. Your fundus needs to be examined for evidence of diabetic retinopathy. As treatment, the basics remain excellent control of blood pressure, target BP being 110/70 mm. Apart from proper control of blood sugars, you must see a nephrologist or an endocrinologist for medical advice after these tests have been done.

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