This document discusses diabetic nephropathy, one of the most serious long-term complications of diabetes. Diabetic nephropathy usually manifests after 10 years of type 1 diabetes or at diagnosis of type 2 diabetes. It is the most common cause of end-stage renal disease in developed countries. Screening for microalbuminuria through urine tests should begin 5 years after diagnosis of type 1 diabetes or at diagnosis of type 2 diabetes to detect early stages of nephropathy. Risk factors that can lead to the development of microalbuminuria include high blood pressure, high blood glucose, dyslipidemia, and smoking. The document provides guidelines on screening, risk factors, and when to refer patients for diabetic

1. EARLY DETECTION OF
DIABETIC NEPHROPATHY
Done by Dr.Nabila Al-Balushi
OMSB Family Medicine, R1423

2. DIABETIC NEPHROPATHY
 One of 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.

3. PREVALENCE OF DIABETIC NEPHROPATHY
 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.

5. SCREENING FOR DIABETIC NEPHROPATHY
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.

6. SCREENING FOR DIABETIC NEPHROPATHY
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.

7.  The National Kidney 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.

8. RISK FACTORS ASSOCIATED WITH
DEVELOPMENT OF MICROALBUMINURIA
 Higher blood pressure
 Higher blood glucose level
 Dyslipidemia
 Smoking

12. WHEN TO REFER THE PATIENT

13. REFERENCES
 Diabetic Nephropathy—The Family 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