Diabetic nephropathy laboratory findings: Difference between revisions
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The diagnosis of diabetic nephropathy depends mostly on urinalysis. The most important finding is documenting the presence of [[albumin]] in the [[urine]]:<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> | The diagnosis of diabetic nephropathy depends mostly on urinalysis. The most important finding is documenting the presence of [[albumin]] in the [[urine]]:<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> | ||
*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. However, if the test is negative, a [[radioimmunoassay]] for [[albumin]] should be done and repeated every year if the initial result is negative. | *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. However, if the test is negative, a [[radioimmunoassay]] for [[albumin]] should be done and repeated every year if the initial result is negative. Conditions such as [[heart failure]], uncontrolled [[hypertension]], [[UTI]] and an acute febrile illness increase the [[albumin]] excretion in the [[urine]] and hence, testing for [[albuminuria]] should not be performed during these conditions. | ||
*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. | *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. | *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. | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dima Nimri, M.D. [2]
Overview
Laboratory Findings
The diagnosis of diabetic nephropathy depends mostly on urinalysis. The most important finding is documenting the presence of albumin in the urine:[1][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. However, if the test is negative, a radioimmunoassay for albumin should be done and repeated every year if the initial result is negative. Conditions such as heart failure, uncontrolled hypertension, UTI and an acute febrile illness increase the albumin excretion in the urine and hence, testing for albuminuria should not be performed during these conditions.
- 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.
- 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
- ↑ 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 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)