– Will get a spot urine albumin/creatinine ratio annually. Screening for microalbuminuria with a spot urine albumin/creatinine ratio identifies the early stages of nephropathy.
– Will also evaluate GFR and Creatinine annually (because diabetic neuropathy may also manifest as increased creatinine or decreased GFR).
“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. Because diabetic nephropathy may also manifest as a decreased glomerular filtration rate or an increased serum creatinine level, these tests should be included in annual monitoring.
Preventive measures include using an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker in normotensive persons. Optimizing glycemic control and using an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker to control blood pressure slow the progression of diabetic nephropathy, but implementing intensive glycemic and blood pressure control is associated with more adverse outcomes. Low-protein diets may also decrease adverse renal outcomes and mortality in persons with diabetic nephropathy.” AAFP
Lisinopril for renoprotection: What is the optimal dose of lisinopril for renoprotection?
The following study tried Lisinopril 20mg, 40mg, and 60 mg. Their conclusion was that lisinopril 40 mg is best. Lisinopril 20mg is acceptable. Lisinopril 60 mg doesn’t offer additional protection.
Diabetic Nephropathy Pearls
-Diabetic nephropathy is the number one cause of kidney failure in the United States. HTN is number 2.
-About 50% of patients with CKD have diabetes mellitus.
-Diabetic nephropathy usually shows up after 10 years’ duration of type 1 diabetes, but may be present at the time of diagnosis of type 2 diabetes.
-Screening for microalbuminuria should be started five years after diagnosis of type 1 diabetes and at time of diagnosis of type 2 diabetes.
-You screen for microalbuminuria by ordering a spot urine albumin/creatinine ratio. 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 microalbuminuria. Microalbuminuria is diagnostic of diabetic nephropathy.
Reference
http://www.aafp.org/afp/2012/0501/p883.html
https://www.ncbi.nlm.nih.gov/pubmed/18974967