Management of Diabetic Nephropathy

Foggensteiner, Lukas; Mulroy, Sharon; Firth, John D.

doi:10.1177/014107680109400504

Cited by 26 publications

(37 citation statements)

References 70 publications

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“…The finding of a trace result should alert the doctor to the possibility that early renal disease is present and, at a minimum, of the need to repeat the test. This approach is consonant with long-accepted guidelines recommending that a test for microalbuminuria be repeated three times before instituting treatment, and also with a recent study showing that the risk is greater when microalbuminuria is present in three urine samples instead of two or one [8, 13, 21]. Emphasizing the importance of urinalysis is not meant to detract from the value of obtaining an immediate, more precise quantitative evaluation of albumin by radioimmunoassay in timed specimens (or albumin to creatinine ratio), but such an approach is neither practical nor always needed.…”

Section: Discussionmentioning

confidence: 68%

“…For the purposes of this article, we used an albumin concentration greater than 20 mg/l as the upper limit of normal for microalbuminuria [13], and a total protein concentration greater than 100 mg/l was considered abnormal [14]. We analyzed the data with Microsoft Excel software (Microsoft Corp., Redmond, Wash., USA) and performed statistical analysis in the standard manner.…”

Section: Methodsmentioning

confidence: 99%

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The Significance of Trace Proteinuria

et al. 2003

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Background: The clinical significance of a trace protein reading on urinalysis is unclear, and such a result is often ignored by the clinician. Methods: We examined 185 samples of urine with trace proteinuria by both Chemstrips and sulfosalicylic acid testing, and compared the results with those of urinary albumin and total protein concentrations. Results: Taking for the purposes of this study an arbitrary upper limit of normal of 20 mg/l for albumin and 100 mg/l for total protein concentration, we found abnormal albumin excretion in 87% and abnormal total protein excretion in 88% of trace samples. In this study, a negative urinalysis for protein excluded microalbuminuria in 87% and proteinuria in 78% of cases. Conclusion: Qualitative testing for protein by urinalysis has a high sensitivity and specificity for diagnosing or ruling out microalbuminuria. Trace proteinuria usually means microalbuminuria; negative proteinuria tends to rule it out.

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Section: Discussionmentioning

confidence: 68%

Section: Methodsmentioning

confidence: 99%

The Significance of Trace Proteinuria

et al. 2003

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“…Aggressive control of hyperglycemia, hypertension, and dyslipidemia help slow the progression of microvascular complications, such as DKD, in diabetic patients. 2 Pathophysiology Diabetic kidney disease is caused by microvascular complications associated with diabetes that lead to changes in renal function and structure causing DKD. The 3 main pathophysiologic pathways leading to DKD that will be focused on in this section include hyperglycemia, hypertension, and dyslipidemia.…”

Section: Epidemiologymentioning

confidence: 99%

“…It is also understood that controlling the modifiable risk factors through lifestyle modification and, when necessary, the addition of medication therapy is of paramount importance in slowing the onset and progression of chronic kidney disease (CKD). [2][3][4][5] The Kidney Disease Outcomes Quality Initiative (K/DOQI) has classified the risk factors associated with CKD as susceptibility, initiation, and progression factors, to facilitate a better understanding of the risks associated with this multifaceted complication. 7 Susceptibility factors contribute to an individual's risk for developing CKD but may not directly cause CKD.…”

Section: Risk Factorsmentioning

confidence: 99%

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Diabetic Kidney Disease: A Renin-Angiotensin-Aldosterone System Focused Review

Hite

DeBellis

2009

Journal of Pharmacy Practice

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Diabetic nephropathy, also referred to as diabetic kidney disease, is a multifaceted complication of one of the largest epidemics in the United States. Diabetic patients currently represent approximately 8% of the US population. Aggressive screening and control of diabetes, hypertension, and dyslipidemia as well as dietary protein restriction are vital to the prevention and management of diabetic kidney disease. Because there are no direct pharmacologic options for diabetic kidney disease, treatment is focused on controlling comorbidities that exacerbate the development and progression of diabetic kidney disease. This article will provide an overview of structural renal alterations during the progression of diabetic kidney disease as well as a concise review of current diabetic kidney disease management guidelines with a focus on agents that affect the renin-angiotensin-aldosterone system. At this point in time, the mainstays of therapy are angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. More research is currently needed to determine if renin inhibitors will have an active role in the management of diabetic kidney disease.

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