22^nd World Nephrology Conference

Diabetics

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Diabetic nephropathy (DN) is typically defined by macro albuminuria—that is, a urinary albumin excretion of more than 300 mg in a 24-hour collection—or macro albuminuria and abnormal renal function as represented by an abnormality in serum creatinine, calculated creatinine clearance, or glomerular filteration filtration rate (GFR). Clinically, diabetic nephropathy is characterized by a progressive increase in proteinuria and decline in GFR, hypertension, and a high risk of cardiovascular morbidity and mortality. Diabetic nephropathy is a clinical syndrome characterized by the following: Proteinuria was first recognized in diabetes mellitus in the late 18th century.

By the 1950s, kidney disease was clearly recognized as a common complication of diabetes, with as many as 50% of patients with diabetes of more than 20 years having this complication Currently, diabetic nephropathy is the leading cause of chronic kidney disease in the United States and other Western societies. It is also one of the most significant long-term complications in terms of morbidity and mortality for individual patients with diabetes. Diabetes is responsible for 30-40% of all end-stage renal disease (ESRD) cases in the United States. Generally, diabetic nephropathy is considered after a routine urinalysis and screening for micro albuminuria in the setting of diabetes. Patients may have physical findings associated with long-standing diabetes mellitus. Good evidence suggests that early treatment delays or prevents the onset of diabetic nephropathy or diabetic kidney disease. Regular outpatient follow-up is key in managing diabetic nephropathy successfully. Recently, attention has been called to atypical presentations of diabetic nephropathy with dissociation of proteinuria from reduced kidney function. Also noted is that micro albuminuria is not always predictive of diabetic nephropathy