Diabetes and Diabetic Kidney Disease
Diabetes is the leading cause of chronic kidney disease in Ireland and worldwide. Around one in three patients with diabetes will develop some degree of kidney involvement during their lifetime. The encouraging news is that with the right treatment, started at the right time, the rate of decline can be slowed substantially and many patients never develop advanced disease.
Dr Rory McQuillan provides specialist nephrology care for patients with diabetic kidney disease, working alongside endocrinology and primary care to deliver integrated treatment.
How diabetes affects the kidneys
Persistent high blood glucose damages the small blood vessels in the kidneys over years. The earliest sign is usually protein in the urine, followed by a gradual decline in filtration. Other diabetic complications, particularly hypertension and cardiovascular disease, accelerate the process. The result over time can be progressive chronic kidney disease and, in some patients, kidney failure.
Who should see a specialist?
GP referral to a nephrologist is appropriate when:
- There is significant protein in the urine (urine ACR above 30)
- Kidney function is declining despite good diabetes control
- The eGFR is below 60 and has not been investigated
- There is hypertension that is hard to control
- There is uncertainty about whether the kidney problem is due to diabetes or another cause
Modern treatment of diabetic kidney disease
Treatment has been transformed in the last decade. The core elements now include:
- Tight blood glucose control with individualised HbA1c targets
- Blood pressure control, typically with an ACE inhibitor or ARB
- SGLT2 inhibitors (such as empagliflozin or dapagliflozin), which slow kidney decline regardless of the diabetes effect
- GLP-1 receptor agonists for cardiovascular and renal benefit
- Newer mineralocorticoid receptor antagonists such as finerenone
- Cholesterol management with statins
- Lifestyle measures: weight management, exercise, diet, and smoking cessation
What patients can do
The most important contributions a patient can make are taking medications consistently, attending review appointments, monitoring blood pressure at home, staying as physically active as practical, eating a balanced diet, and not smoking. Even small improvements in each of these areas add up to a meaningful long-term benefit on kidney function.
Appointments
Appointments are arranged through GP referral, often in conjunction with endocrinology.
Frequently Asked Questions
No. Around one in three patients with diabetes develops kidney involvement, and many do not progress to advanced disease with modern treatment.
Blood pressure control, blood glucose control, and starting an SGLT2 inhibitor at the right time are the three most impactful interventions.
Most patients with diabetic kidney disease and reasonable kidney function benefit from an SGLT2 inhibitor. The decision is individualised based on your full medical picture.
With optimal treatment, the rate of decline can be slowed substantially. Many patients live a normal lifespan without progressing to dialysis.
Have a Question?
If you’d like more information about Dr. McQuillan’s services or need assistance from the practice team, please get in touch below.
Please note: Appointments are arranged via GP referral.