Diabetic Nephropathy

Diabetic Nephropathy is a topic covered in the Washington Manual of Medical Therapeutics.

To view the entire topic, please or .

The Washington Manual of Medical Therapeutics helps you diagnose and treat hundreds of medical conditions. Consult clinical recommendations from a resource that has been trusted on the wards for 50+ years. Explore these free sample topics:

-- The first section of this topic is shown below --

General Principles

Epidemiology

Approximately 25%–45% of patients with either type of diabetes develop clinically evident diabetic nephropathy during their lifetime. Diabetic nephropathy is the leading cause of end-stage renal disease (ESRD) in the United States and a major cause of morbidity and mortality in patients with diabetes.1

Risk Factors

The newest ADA guidelines no longer distinguish between microalbuminuria and macroalbuminuria, defining albuminuria as urinary albumin-to-creatinine ratio ≥30 mg/g.1 The mean duration from diagnosis of T1DM to the development of overt proteinuria has increased significantly and is now >25 years. The time from the occurrence of proteinuria (albumin/creatinine >300 mg/g) to ESRD has also increased and is now >5 years. In T2DM, albuminuria can be present at the time of diagnosis. Poor glycemic control is the major risk factor for diabetic nephropathy, but hypertension and smoking are contributors. Obesity may contribute to kidney damage in T2DM. Owing to the widespread use of ACE inhibitor and ARB agents for the treatment of hypertension, impaired kidney function may occur in the absence of albuminuria.1

Prevention

Prevention of diabetic nephropathy starts at the time of diagnosis with achievement of glycemic, blood pressure, and lipid targets. Smoking cessation is also important. Annual screening for albuminuria and measurement of serum creatinine identify those with early damage who are at risk of progression. Annual screening should be performed in T1DM patients who have had diabetes for >5 years and all T2DM patients starting at diagnosis.

Associated Conditions

  • Patients with proteinuria (albumin/creatinine >300 mg/g) are at higher risk for anemia because of loss of transferrin and poor production of erythropoietin and should be screened at any stage of CKD and treated.
  • Patients with CKD are at higher risk for CVD and mortality, so management of other CV risk factors is particularly important in this group of patients.
  • Hypovitaminosis D should be corrected, and secondary hyperparathyroidism should be prevented or treated as early as possible.
  • Patients with diabetes and CKD may be at risk for hyperkalemia and metabolic acidosis, which should be identified and managed accordingly.

-- To view the remaining sections of this topic, please or --

General Principles

Epidemiology

Approximately 25%–45% of patients with either type of diabetes develop clinically evident diabetic nephropathy during their lifetime. Diabetic nephropathy is the leading cause of end-stage renal disease (ESRD) in the United States and a major cause of morbidity and mortality in patients with diabetes.1

Risk Factors

The newest ADA guidelines no longer distinguish between microalbuminuria and macroalbuminuria, defining albuminuria as urinary albumin-to-creatinine ratio ≥30 mg/g.1 The mean duration from diagnosis of T1DM to the development of overt proteinuria has increased significantly and is now >25 years. The time from the occurrence of proteinuria (albumin/creatinine >300 mg/g) to ESRD has also increased and is now >5 years. In T2DM, albuminuria can be present at the time of diagnosis. Poor glycemic control is the major risk factor for diabetic nephropathy, but hypertension and smoking are contributors. Obesity may contribute to kidney damage in T2DM. Owing to the widespread use of ACE inhibitor and ARB agents for the treatment of hypertension, impaired kidney function may occur in the absence of albuminuria.1

Prevention

Prevention of diabetic nephropathy starts at the time of diagnosis with achievement of glycemic, blood pressure, and lipid targets. Smoking cessation is also important. Annual screening for albuminuria and measurement of serum creatinine identify those with early damage who are at risk of progression. Annual screening should be performed in T1DM patients who have had diabetes for >5 years and all T2DM patients starting at diagnosis.

Associated Conditions

  • Patients with proteinuria (albumin/creatinine >300 mg/g) are at higher risk for anemia because of loss of transferrin and poor production of erythropoietin and should be screened at any stage of CKD and treated.
  • Patients with CKD are at higher risk for CVD and mortality, so management of other CV risk factors is particularly important in this group of patients.
  • Hypovitaminosis D should be corrected, and secondary hyperparathyroidism should be prevented or treated as early as possible.
  • Patients with diabetes and CKD may be at risk for hyperkalemia and metabolic acidosis, which should be identified and managed accordingly.

There's more to see -- the rest of this entry is available only to subscribers.