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]
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 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. 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)