A spot urine sample should be analyzed for albumin and creatinine and an albumin: creatinine ratio calculated on a yearly basis, beginning at diagnosis in those
with type 2 diabetes and after 5 years of diabetes in those with type 1. A ratio of less than 30 mg albumin/g creatinine is considered norma]. Microalbuminuria is 30-300 mg/g creatinine; more than 300 mg/g is considered macroalbuminuria. As there are many causes of transient proteinuria, including exercise, fever, and urinary-tract infections, it is suggested that this test be performed on three separate occasions (with two of the three positive) before the patient is considered to have clinically significant albuminuria.
Using this test, patients who require aggressive treatment can be identified, thereby minimizing the risk of progressive nephropathy. Factors important in the reduction of risk for diabetic nephropathy include the control of blood glucose and treatment of hypertension. As in hypertension, ACE inhibitors are the drugs of choice in the treatment of albuminuria. For patients who cannot tolerate ACE inhibitors, the September 20th, 2001, issue of the New England Journal of Medicine contained three papers showing the utility of angiotensin receptor blockers in diabetic nephropathy (9-11).
Comment-. When to begin screening children with type 1 diabetes is a controversial topic. Although previously it was felt that duration of diabetes prior to puberty was not clinically significant, there is now increasing evidence that the duration of diabetes should be considered regardless of pubertal status, and it is recommended that all patients with type 1 diabetes be screened after 5 years of disease.
Was this article helpful?
Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...