Diabetic nephropathy screening

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]

Microalbuminuria is an excellent tool for the early detection of diabetic nephropathy.

• 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]

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