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Diagnosis and Treatment of Diabetic Nephropathy SFM Didactics January 14, 2003 Carol Cordy, MD. 1. Why should you screen for diabetic nephropathy? 2. How should you screen for diabetic nephropathy? 3. What should you do with the results of your screening tests?. Why screen? Why treat?.
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1.Why should you screen for diabetic nephropathy?2. How should you screen for diabetic nephropathy?3. What should you do with the results of your screening tests?
Prevention and treatment of diabetic nephropathy can reduce the incidence of end stage renal disease and death
Type 1 Diabetic
Type 2 Diabetic
time of presentation probably secondary
progress to overt nephropathy
higher incidence of diabetic nephropathy
- creatinine clearance <70 ml/min
- creatinine clearance <15 ml/min
- creatinine = 6mg/dl
Studies show that primary care physicians screen only 20% oftheir diabetic patients for diabetic nephropathy
Once screened many physicians are not sure what to do with the results
The use of the algorithm will improve renal function screening in the diabetic population and encourage the initiation of appropriate therapy in patients with all stages of renal disease
*This is the most practical test
Factors that Cause False Positive Test
Type 1 Diabetes
Type 2 Diabetes
(some say <6.5%)
Your first patient is a 25 year old young man with a 5 year history of type 1 diabetes. His urine dipstick is negative for protein. You check a spot AM urine alb/cr ratio which is .019. His blood pressure is 112/66. His HbA1C is 6.9.
Your next patient is a 43 year old woman with a six year history of type 2 diabetes. A urine dip shows trace protein and a spot AM urine alb/cr ratio is .039. Her blood pressure is 135/80 and her HbA1C is 6.7.
Your last patient is a 60 year old with HTN, dyslipidemia and newly diagnosed type 2 diabetes. A urine dip shows 2+ protein. He has a fever and his HbA1C is 10.3. His blood pressure is 140/88. He is taking HCTZ and glipizide.
Three months later with exercise, metformin and enalapril your patient’s HbA1C is now 7.5 and his blood pressure is 135/85. A urine dip now shows 1+ protein.