Glomerulosclerosis screening

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T2DM NEPHROPATHY SCREENING: Check eGFR*, creatinine and ACR at diagnosis and annually thereafter.

Diabetic nephropathy is diagnosed if the person has persistent albuminuria**, other characteristic features are arterial hypertension and a progressive decline in kidney function (eGFR).

ACR (mg/mmol)

 Albumin concentration

Treatment Targets

Microalbuminuria

Male: 2.5-30

Female: 3.5-30

 30-300 mg / 24 hrs
  • ACEI (or ATII) if not contra-indicated, regardless of BP and titrate to maximum tolerated dose.
  • Maintain BP < 130/80
  • Target HbA1c (agree with patient see diabetic control section)
    • < 48 mmol/mol if eGFR > 60 (G1 + G2)
    • 48 – 53 mmol/mol (6.5% – 7%) in CKD G3a
    • 53 – 68 mmol/mol in CKD G3b/G4 (individualisation of patient target)
  • Atorvastatin 20mg (as per cholesterol section)

 

Proteinuria (low)

 30 – 70 0.5gm/24 hrs
Proteinuria (high)  > 70

1gm/24 hrs
* Advise patients to avoid meat for 12 hours before eGFR/cr test….more [icon type=”info-circle”]

** Albuminuria is diagnosed by measuring the albumin:creatinine ratio (ACR) on a first-pass morning urine sample (a spot sample can be used, but the test will need to be repeated on a first-pass morning sample if the result is abnormal):

  • If abnormal (in the absence of proteinuria or urinary tract infection), repeat two more times within 4 months.
  • Albuminuria is confirmed if either of these subsequent tests is also abnormal.

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