Diabetic nephropathy screening: Difference between revisions
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==Overview== | ==Overview== | ||
Microalbuminuria is an excellent tool for the early detection of [[diabetic nephropathy]]. | |||
==Screening== | ==Screening== | ||
[[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 do not rule out [[microalbuminuria]]. Hence, if the test is positive, a 24-hour urine sample for quantifying the amount of [[protein]] should be done | * [[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> | ||
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> | * Screening for [[albuminuria]] is done with a routine dipstick [[urinalysis]]. However, routine dipsticks do not rule out [[microalbuminuria]]. Hence, if the test is positive, a 24-hour urine sample for quantifying the amount of [[protein]] should be done and 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> | |||
* 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> | |||
==References== | ==References== | ||
Latest revision as of 20:36, 13 June 2018
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Diabetic nephropathy Microchapters |
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Diabetic nephropathy screening On the Web |
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American Roentgen Ray Society Images of Diabetic nephropathy screening |
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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], Dima Nimri, M.D. [3]
Overview
Microalbuminuria is an excellent tool for the early detection of diabetic nephropathy.
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 do not rule out microalbuminuria. Hence, if the test is positive, a 24-hour urine sample for quantifying the amount of protein should be done and 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
- ↑ 1.0 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.
- ↑ 2.0 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)