Diabetic nephropathy: preventing progression

Overview

Diabetic nephropathy is a clinical syndrome in people with diabetes, characterised by albuminuria on at least two occasions separated by 3 to 6 months. Diabetic nephropathy is usually accompanied by hypertension, progressive rise in proteinuria, and decline in renal function. In type 1 diabetes, five stages have been proposed (see table 1).[1][2] Of these, stages 1 and 2 are equivalent to pre-clinical nephropathy, and are detected only by imaging or biopsy. Stage 3 is synonymous with early nephropathy — the clinical term used in this review. ...read more. Stage 4 nephropathy is also known clinically as late nephropathy, and this term will be used for the remainder of this review. Stage 5 represents the progression to end-stage renal disease. Population: For the purpose of this review, we have included people with diabetes and both early and late nephropathy. Early nephropathy presents as microalbuminuria, usually defined by albuminuria level of 30 to 300 mg a day (or albumin/creatinine ratio of 30 to 300 mg/g [3.4–34.0 mg/mmol]). Late nephropathy presents as macroalbuminuria, characterised by albuminuria greater than 300 mg a day (or albumin/creatinine ratio greater than 300 mg/g [34 mg/mmol]). The treatment of people with diabetes and end-stage renal disease is not covered in this review.

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