Diabetic kidney disease is a major caused of morbidity and premature death, in diabetic patients.
It is multistage condition that requires many years before becoming clinically overt.
An estimated 5% to 15% of DM 2 cases also progress through the five stages of diabetic nephropathy (DN), but the timeline is not as clear. Some patients advance through the stages very quickly.
|Raised blood pressure|
|Baseline urinary albumin excretion|
|Duration of diabetes|
|Presence of retinopathy|
|Raised cholesterol and triglyceride levels|
|Raised serum homocysteine levels|
Incipient nephropathy is the stage of microalbuminuria;
Albumin excretion can be estimated through the following methods:
|24 hour collection||Timed collection||Spot collection|
|mg / 24 hours||ug / min||ug/mg Creatinine|
|Normal||< 30||< 20||< 30|
|Microalbuminuria||30 - 300||20 - 200||30 - 300|
|MacroAlbuminuria||> 300||> 200||> 300|
Urinary albumin excretion (UAE) has a marked intra-individual day to day variation which may be up to 50% thus, in patients with an increase in the urinary albumin excretion rate, or a persistent proteinuria, the UAE should be measured in sterile urine on 3 different intervals over a 4-6 month period.
Albumin to creatinine ratio >30mg/g in an untimed urine specimen is a good predictor of the development of overt nephropathy during an 8 year followup period.
Other condition which lead to an increase in UAE should be ruled out; more than 30% patients with raised UAE and/or persistent proteinuria may have an extra renal cause.
INCIPIENT DIABETIC NEPHROPATHY (DIABETIC MICRO ALBUMINURIA) SHOULD ONLY BE DIAGNOSED WHEN SEEN TO BE PRESENT ON REPEAT TESTING AND WHEN OTHER CAUSES OF RAISED URINARY ALBUMIN HAVE BEEN EXCLUDED.
If tests for microalbuminuria are negative, RETEST regularly.
Renal replacement therapy (dialysis and / or renal transplant) is the treatment for end stage renal disease (ESRD).