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Abstract
Early intervention in patients with diabetes may slow the progression of kidney disease, and early recognition of renal impairment is critical in order to achieve optimal patient outcomes. Annual screening for the presence of albuminuria is recommended in type 1 diabetic patients with diabetes duration of ≥ 5 years and in all type 2 diabetic patients. But, due to the inadequacies of albuminuria screening, serum creatinine and estimated glomerular filtration rate (GFR) should be evaluated at least annually in all adults with diabetes regardless of urine albumin excretion levels. Once diabetic nephropathy is detected, optimal management focused on multiple risk factor interventions should be accompanied. Currently, there are tremendous ongoing efforts to identify better markers for early diagnosis of diabetic nephropathy, and to develop better therapeutic approaches.
REFERENCES
1. SAmerican Diabetes Association. Standards of medical care in diabetes-2013. Diabetes Care. 2013; 36(Suppl 1):S11–66.
2. SMolitch ME, DeFronzo RA, Franz MJ, Keane WF, Mogensen CE, Parving HH, Steffes MW. American Diabetes Association. Nephropathy in diabetes. Diabetes Care. 2004; 27:S79–83.
3. SPerkins BA, Ficociello LH, Silva KH, Finkelstein DM, Warram JH, Krolewski AS. Regression of microalbuminuria in type 1 diabetes. N Engl J Med. 2003; 348:2285–93.
4. SGosmanov AR, Gosmanova EO. Long-term renal outcomes of patients with type 1 diabetes mellitus and microalbuminuria: an analysis of the DCCT/EDIC cohort. Arch Intern Med. 2011; 171:412–20.
5. SKramer HJ, Nguyen QD, Curhan G, Hsu CY. Renal insufficiency in the absence of albuminuria and retinopathy among adults with type 2 diabetes mellitus. JAMA. 2003; 289:3273–7.
6. SLee JE, Won KC, Lee HW, Yoon JS. Clinical significance of decreased glomerular filtration rate (GFR) without albuminuria among type 2 diabetics. Korean Diabetes J. 2008; 32:252–8.
7. SLevey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, Hogg RJ, Perrone RD, Lau J, Eknoyan G. National Kidney Foundation. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med. 2003; 139:137–47.
8. SLevey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J. CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009; 150:604–12.
9. SPerkins BA, Nelson RG, Ostrander BE, Blouch KL, Krolewski AS, Myers BD, Warram JH. Detection of renal function decline in patients with diabetes and normal or elevated GFR by serial measurements of serum cystatin C concentration: results of a 4-year followup study. J Am Soc Nephrol. 2005; 16:1404–12.
10. SWeinert LS, Camargo EG, Soares AA, Silveiro SP. Glomerular filtration rate estimation: performance of serum cystatin C-based prediction equations. Clin Chem Lab Med 2011:49. 1761–71.
11. SACCORD Study Group. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010; 362:1575–85.
12. SBarnett AH, Bain SC, Bouter P, Karlberg B, Madsbad S, Jervell J, Mustonen J. Diabetics Exposed to Telmisartan and Enalapril Study Group. Angiotensin-receptor blockade versus converting-enzyme inhibition in type 2 diabetes and nephropathy. N Engl J Med. 2004; 351:1952–61.
13. SHollenberg NK, Parving HH, Viberti G, Remuzzi G, Ritter S, Zelenkofske S, Kandra A, Daley WL, Rocha R. Albuminuria response to very high-dose valsartan in type 2 diabetes mellitus. J Hypertens. 2007; 25:1921–6.
14. SMann JF, Schmieder RE, McQueen M, Dyal L, Schumacher H, Pogue J, Wang X, Maggioni A, Budaj A, Chaithiraphan S, Dickstein K, Keltai M, Metsärinne K, Oto A, Parkhomenko A, Piegas LS, Svendsen TL, Teo KK, Yusuf S. ONTARGET investigators. Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): a multicentre, randomised, double-blind, controlled trial. Lancet. 2008; 372:547–53.
15. SParving HH, Persson F, Lewis JB, Lewis EJ, Hollenberg NK. AVOID Study Investigators. Aliskiren combined with losartan in type 2 diabetes and nephropathy. N Engl J Med. 2008; 358:2433–46.
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