screening for Diabetic kidney disease
harry206 - 05-03-09 15:48

BEST way to screen for diabetic kidney disease:
Urine microalbumin/creatinine ratio
- Its advantages include ease of use, relatively low cost, and good correlation with 24-hour urine values.
- Since albumin concentration is influenced by urine volume, calculating a ratio between microalbumin and creatinine eliminates the influence of volume, and offers improved sensitivity and specificity compared with spot urine microalbumin alone
- A random spot urine microalbumin/creatinine ratio is normally less than 30 mg/g.
- Patients with a large muscle mass have a high rate of creatinine excretion ---> result in a falsely negative microalbumin/creatinine ratio.
- Fever, vigorous exercise, heart failure, and poor glycemic control can cause transient microalbuminuria -----> resulting in false-positive microalbumin/creatinine ratios
- Type 2 diabetes mellitus and microalbuminuria----> likelihood of progressing to overt nephropathy is nearly equal to that of a similar patient with type 1 diabetes
- Next most appropriate step in the evaluation and management of microalbuminuria (in diabetic) : ACE Inhibitor
- The combination of diabetic retinopathy (a marker for diabetic renal disease), hypertension (BP > 130/80 mm Hg in a diabetic), and abnormal protein in the urine as measured by the urine microalbumin/creatinine ratio is sufficient to make the diagnosis of diabetic nephropathy.
- When creatinine clearance decreases, patients on metformin are at higher risk of developing the rare adverse effect of lactic acidosis, so stopping metformin in renal failure continues to be the standard of care.
- Non-dihydropyridine calcium channel blockers reduce protein excretion in diabetics with nephropathy and slow the progression of renal disease