Diabetic nephropathy screening

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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. 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)



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