Q: Can you please list the various tests to be done for kidney functioning besides creatinine levels for a diabetic patient who is on insulin, with poor blood sugar control? What other tests are essential under such conditions? Please enlist them.

A:The creatinine clearance and 24 hour urine excretion of protein should be checked. If the proteinuria is not high, then microalbuminuria should be looked for in 24 hours urine. These tests should be done only after making sure there is no urine infection. If all these tests are normal, and 20 years of diabetes have elapsed, then it is unlikely that nephropathy will develop afresh now. However, it is important to remember that: 1. BP should be kept under tight control, because that can cause kidney damage also, and 2. Eye damage (retinopathy) is inevitable and 20 years of diabetes, especially poorly controlled diabetes, means you should be getting regular retinal checks, and making sure that retinopathy is dealt with adequately.