Endocrine » Diabetes

Diabetic Nephropathy

Diabetic nephropathy is a clinical syndrome characterized by persistent albuminuria (> 300 mg/day or > 200 mcg/min) that is confirmed on at least 2 occasions 3-6 months apart, a relentless decline in GFR and elevated arterial blood pressure. It is one of the leading cause of chronic renal failure and one of the most significant long-term complications in terms of morbidity and mortality for diabetics. Screening of microalbuminuria is recommended yearly for all patients with type 1 diabetes after the diabetes has lasted for 5 years and for patients with type 2 diabetes from the time of diagnosis. Investigations include routine urinalysis and 24-hour urine estimation for urea, creatinine and protein to quantify protein losses and estimating the GFR. Management includes Glycaemic control, antihypertensive treatment. An ACE inhibitor is always the drug of choice for type 1 diabetics, modification and/or treatment of associated risk factors such as hyperlipidaemia, smoking and hypertension, renal replacement therapy like haemodialysis, peritoneal dialysis or kidney transplantation. Prevention by optimal blood glucose control, control of hypertension, early detection and optimal management of diabetes, especially in the setting of family history of diabetes.

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