Diabetic nephropathy screening

Diabetic nephropathy Microchapters
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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]

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, since about 7% of patients may have damaged kidneys even in early stages of diabetes.
• Minute levels of albumin (microalbuminuria) in the urine are not detectable with routine urine protein dipsticks.
• The incidence of diabetic nephropathy may particularly increase in patients with poor glycemic control, systemic hypertension and hyperlipidemia.
• If microalbuminuria is not present, the test must be repeated annually for both 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)