Diabetic nephropathy screening: Difference between revisions

Jump to navigation Jump to search
No edit summary
Line 7: Line 7:


==Screening==
==Screening==
* [[Screening]] for nephropathy in diabetes should begin at the time of diagnosis of [[type II diabetes mellitus]], since about 7% of patients may have damaged kidneys even in early stages of [[diabetes]].
[[Screening]] for nephropathy in diabetes should begin at the time of diagnosis of [[type II diabetes mellitus]]<ref name="pmid11948275">{{cite journal |vauthors=Remuzzi G, Schieppati A, Ruggenenti P |title=Clinical practice. Nephropathy in patients with type 2 diabetes |journal=N. Engl. J. Med. |volume=346 |issue=15 |pages=1145–51 |year=2002 |pmid=11948275 |doi=10.1056/NEJMcp011773 |url=}}</ref> and after 5 years of the diagnosis of [[type I diabetes mellitus]].<ref name="pmid25342915">{{cite journal |vauthors=Lim AKh |title=Diabetic nephropathy - complications and treatment |journal=Int J Nephrol Renovasc Dis |volume=7 |issue= |pages=361–81 |year=2014 |pmid=25342915 |pmc=4206379 |doi=10.2147/IJNRD.S40172 |url=}}</ref> Screening for [[albuminuria]] is done with a routine dipstick [[urinalysis]]. However, routine dipsticks does not rule out [[microalbuminuria]]. Hence, if the test is positive, a 24-hour urine sample for quantifying the amount of [[protein]] should be done. However, if the test is negative, a [[radioimmunoassay]] for [[albumin]] should be done and repeated every year if the initial result is negative. The [[albumin]] to [[creatinine]] ratio should also be measured in a morning [[urine]] sample, a 24-hour or an overnight sample. In the case of an abnormal urine [[albumin]] to [[creatinine]] ratio (more than 30 mg/ g Cr), test should be repeated once or twice over a period of few months for consistency of the results. Estimated [[GFR]] ([[eGFR]]) is often calculated at the time of screening to document and/or stage [[chronic kidney disease]] ([[CKD]]). If [[retinopathy]] is present along with [[albuminuria]], the [[albuminuria]] is highly attributed to diabetic nephropathy.<ref name="pmid11948275">{{cite journal |vauthors=Remuzzi G, Schieppati A, Ruggenenti P |title=Clinical practice. Nephropathy in patients with type 2 diabetes |journal=N. Engl. J. Med. |volume=346 |issue=15 |pages=1145–51 |year=2002 |pmid=11948275 |doi=10.1056/NEJMcp011773 |url=}}</ref><ref name="pmid25342915">{{cite journal |vauthors=Lim AKh |title=Diabetic nephropathy - complications and treatment |journal=Int J Nephrol Renovasc Dis |volume=7 |issue= |pages=361–81 |year=2014 |pmid=25342915 |pmc=4206379 |doi=10.2147/IJNRD.S40172 |url=}}</ref><br>
* Minute levels of [[albumin]] ([[microalbuminuria]]) in the urine are not detectable with routine urine protein dipsticks.
New genetic markers are being studied for diabetic nephropathy. These markers are being determined in order to facilitate an early identification and management of patients at a high risk of developing diabetic nephropathy.<ref name="pmid25342915">{{cite journal |vauthors=Lim AKh |title=Diabetic nephropathy - complications and treatment |journal=Int J Nephrol Renovasc Dis |volume=7 |issue= |pages=361–81 |year=2014 |pmid=25342915 |pmc=4206379 |doi=10.2147/IJNRD.S40172 |url=}}</ref>
* The incidence of diabetic nephropathy may particularly increase in patients with [[hyperglycemia|poor glycemic control]], [[systemic hypertension]] and [[hyperlipidemia]].
* If [[microalbuminuria]] is not present, the test must be repeated annually for both [[type I diabetes mellitus|type I]] and [[type II diabetes mellitus]] patients.
* There are two ways to screen patients for diabetic nephropathy:
** Spot urine sample test
** 24 hour and timed urine collection
* The spot urine sample collection is preferred as it is convenient to perform and has a high [[sensitivity]] as well as [[specificity]]. The 24 hour and timed urine collection method is cumbersome and is inaccurate because of improper urine collection techniques and timing.
* The [[albumin]] levels in the urine can be recorded in two ways:
** As concentration (in mg/dl)
** As a ratio ([[albumin]] : [[creatinine]] ratio)


==References==
==References==

Revision as of 14:56, 30 November 2016

Diabetic nephropathy Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Diabetic nephropathy from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Diabetic nephropathy screening On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Diabetic nephropathy screening

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Diabetic nephropathy screening

CDC on Diabetic nephropathy screening

Diabetic nephropathy screening in the news

Blogs on Diabetic nephropathy screening

Directions to Hospitals Treating Diabetic nephropathy

Risk calculators and risk factors for Diabetic nephropathy screening

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]

Overview

Microalbumin levels in the urine is an excellent tool to look for early damage to kidneys secondary to diabetes. Albumin is a protein found normally in the serum, but it gets completely absorbed from the renal tubules when it is filtered into the nephron from the glomerulus. Hence, a damaged nephron will not reabsorb the albumin filtered by the glomerulus and it appears in the urine.

Screening

Screening for nephropathy in diabetes should begin at the time of diagnosis of type II diabetes mellitus[1] and after 5 years of the diagnosis of type I diabetes mellitus.[2] Screening for albuminuria is done with a routine dipstick urinalysis. However, routine dipsticks does not rule out microalbuminuria. Hence, if the test is positive, a 24-hour urine sample for quantifying the amount of protein should be done. However, if the test is negative, a radioimmunoassay for albumin should be done and repeated every year if the initial result is negative. The albumin to creatinine ratio should also be measured in a morning urine sample, a 24-hour or an overnight sample. In the case of an abnormal urine albumin to creatinine ratio (more than 30 mg/ g Cr), test should be repeated once or twice over a period of few months for consistency of the results. Estimated GFR (eGFR) is often calculated at the time of screening to document and/or stage chronic kidney disease (CKD). If retinopathy is present along with albuminuria, the albuminuria is highly attributed to diabetic nephropathy.[1][2]
New genetic markers are being studied for diabetic nephropathy. These markers are being determined in order to facilitate an early identification and management of patients at a high risk of developing diabetic nephropathy.[2]

References

  1. 1.0 1.1 Remuzzi G, Schieppati A, Ruggenenti P (2002). "Clinical practice. Nephropathy in patients with type 2 diabetes". N. Engl. J. Med. 346 (15): 1145–51. doi:10.1056/NEJMcp011773. PMID 11948275.
  2. 2.0 2.1 2.2 Lim A (2014). "Diabetic nephropathy - complications and treatment". Int J Nephrol Renovasc Dis. 7: 361–81. doi:10.2147/IJNRD.S40172. PMC 4206379. PMID 25342915. Vancouver style error: initials (help)

Template:WH Template:WS