title: Diabetic nephropathy for the primary care provider: new understandings on early detection and treatment.
abstract: BACKGROUND
  Diabetic nephropathy is the leading cause of renal disease in the United States, occurring in 20%-40% of patients with diabetes. This condition is a distinct manifestation of diabetic renal disease seen in patients with type 1 and type 2 diabetes. Despite clear screening and management recommendations, diabetic nephropathy remains substantially underdiagnosed.
  
  
  METHODS
  This review presents recent guidelines and recommendations from varied work groups to identify, monitor, and halt the progression of diabetic nephropathy. Our search of the recent literature focused on diagnostic criteria, the latest screening recommendations, novel screening methods, current research, new treatment recommendations, and goals for early intervention.
  
  
  RESULTS
  Current recommendations for early detection and treatment of diabetic nephropathy include yearly albumin to creatinine ratio checks and more frequent tests if indicated based on glomerular filtration rate and albuminuria; optimizing glucose control with a target hemoglobin A1c goal of <7%; initiating angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) as the first line in disease management with dual therapy of ACE inhibitors and ARBs no longer recommended; managing blood pressure with a goal of <140/90 mmHg as the target for all patients with diabetes; and initiating statin therapy for patients <50 years old and with concomitant chronic kidney disease and diabetes and in all patients with chronic kidney disease >50 years of age regardless of the coexistence of diabetes.
  
  
  CONCLUSIONS
  With early detection, proper screening, and management, the impact of diabetic nephropathy may be better mitigated to lessen its impact on society and healthcare.
authors.affiliation: Department of Internal Medicine, University of Illinois at Chicago College of Medicine and Advocate Christ Medical Center, Oak Lawn, IL.
authors.forename: Andrew
authors.initials: A
authors.lastname: Kowalski
authors.affiliation: Department of Internal Medicine, University of Illinois at Chicago College of Medicine and Advocate Christ Medical Center, Oak Lawn, IL.
authors.forename: Armand
authors.initials: A
authors.lastname: Krikorian
authors.affiliation: Section of Nephrology, Department of Internal Medicine, University of Illinois at Chicago College of Medicine and Advocate Christ Medical Center, Oak Lawn, IL.
authors.forename: Edgar V
authors.initials: EV
authors.lastname: Lerma
keywords: Albuminuria; diabetes mellitus; diabetic nephropathies; early diagnosis; primary health care; renal insufficiency–chronic