[How I evaluate...diabetic nephropathy. First part: micro- and macroalbuminuria].
Diabetic nephropathy (DN) appears in about 30% of patients with type 1 diabetes (D1) and 15 to 60% of patients with type 2 diabetes (D2). It is preceded by microalbuminuria. Microalbuminuria is defined as an albumin excretion rate between 30 and 300 mg/24 h (on a 24-hour urine collection) or between 20 and 200 micrograms/min (on an overnight collection) in at least two out of three consecutive collections made within a 6-month period. Alternative screening techniques use either dipstick (Micral-Test II) or the albumin to creatinine ratio on an early morning urine sample (30-300 mg/g creatinine). Once persistent microalbuminuria is confirmed, 80% of type 1 diabetic patients and 20 to 50% of type 2 diabetic patients will progress to DN. In D2, microalbuminuria also represents a powerful predictor of early mortality from cardiovascular disease. Macroalbuminuria (AER > 300 mg/24 h, corresponding to a total protein excretion > 500 mg/24 h) will eventually lead to a end-stage renal insufficiency within 10 to 20 years. In D2, numerous patients will die from cardiovascular disease before reaching end-stage renal failure. Angiotensin-converting enzyme inhibitors can slow down the evolution toward DN when prescribed when microalbuminuria appears. Screening for microalbuminuria should therefore be a part of the annual clinical assessment in every diabetic patient.
Weekers
L
L
Département de Médecine, Université de Liège.
Scheen
A J
AJ
Lefebvre
P J
PJ
D000419:Albuminuria / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy / Q000652:urine; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality; D003663:Decision Trees; D003928:Diabetic Nephropathies / Q000209:etiology*; D018450:Disease Progression; D006801:Humans; D008403:Mass Screening / Q000379:methods; D011379:Prognosis
D000806:Angiotensin-Converting Enzyme Inhibitors