Early detection of diabetic nephropathy

Early detection of diabetic nephropathy

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  EARLY DETECTION OF DIABETICNEPHROPATHY Done by Dr.Nabila Al-Balushi OMSB Family Medicine, R1423
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  DIABETIC NEPHROPATHY  Oneof the most serious long-term complications of diabetes mellitus (DM).  Among all diabetes complications diabetic nephropathy is the diabetes specific complication with the greatest mortality.  Diabetic nephropathy usually manifests after 10 years’ duration of type 1 diabetes, but may be present at diagnosis of type 2 diabetes.
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  PREVALENCE OF DIABETICNEPHROPATHY  The most common single cause of ESRD in the USA and Europe, as well as in many developed countries.  Worldwide, the number of patients with diabetes receiving renal replacement therapy has doubled from 12.7 million in 1990- 1991 to 23.6 million in 1998-1999.  In 2000, the age-adjusted prevalence of diabetes among Omanis aged 30-64 years reached 16.1% compared with 12.2% in 1991, indicating an increasing prevalence.
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  SCREENING FOR DIABETICNEPHROPATHY 1. Screening for microalbuminuria with a spot urine albumin/creatinine ratio identifies the early stages of nephropathy.  Positive results on two of three tests (30 to 300 mg of albumin per g of creatinine) in a six-month period meet the diagnostic criteria for diabetic nephropathy.  Screening for microalbuminuria should be initiated five years after diagnosis of type 1 diabetes and at diagnosis of type 2 diabetes.   Should be done annually for both type 1 and type2.
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  SCREENING FOR DIABETICNEPHROPATHY Because diabetic nephropathy may also manifest as a decreased Glomerular Filtration Rate (GFR) or an increased Serum Creatinine level, these tests should be included in annual monitoring.
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   The NationalKidney Foundation recommends that all persons with chronic kidney disease undergo renal ultrasonography to distinguish potentially reversible causes of kidney disease.  Several conditions should prompt consideration of renal biopsy to identify non-diabetic causes of renal disease.
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  RISK FACTORS ASSOCIATEDWITH DEVELOPMENT OF MICROALBUMINURIA  Higher blood pressure  Higher blood glucose level  Dyslipidemia  Smoking
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  WHEN TO REFERTHE PATIENT
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  REFERENCES  Diabetic Nephropathy—TheFamily Physician’s Role. MICHELLE A. ROETT, MD, MPH; SARAH LIEGL, MD; and YALDA JABBARPOUR, MD, Georgetown University Medical Center, Washington, District of Columbia  Prevalence and Risk Factors of Diabetic Nephropathy in Omani Type 2 Diabetics in Al-Dakhiliyah Region Abdulhakeem Hamood Alrawahi, Syed Gauhar A. Rizvi, Dawood Al-Riami, Zaher Al-Anqoodi Received: 25 Jan 2012 / Accepted: 14 Mar 2012 © OMSB, 2012