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Diabetic Proteinuria

Nice Guidance - Diabetic Renal Disease In Type Ii Diabetes - General Practice Notebook

Nice Guidance - Diabetic Renal Disease In Type Ii Diabetes - General Practice Notebook

NICE guidance - diabetic renal disease in type II diabetes Summary points from the guidance include: Microalbuminuria is the earliest indicator of renal disease (nephropathy) attributable to diabetes. A review of longitudinal studies has shown microalbuminuria to be predictive of total mortality, cardiovascular mortality and cardiovascular morbidity. NICE have stated regarding diabetes and kidney disease (1): ask all people with or without detected nephropathy to bring in a first-pass morning urine specimen once a year in the absence of proteinuria/urinary tract infection (UTI), send this for laboratory estimation of albumin:creatinine ratio request a specimen on a subsequent visit if UTI prevents analysis make the measurement on a spot sample if a first-pass sample is not provided (and repeat on a first-pass specimen if abnormal) or make a formal arrangement for a first-pass specimen to be provided measure serum creatinine and estimate the glomerular filtration rate (using the method-abbreviated modification of diet in renal disease [MDRD] four-variable equation) annually at the time of albumin:creatinine ratio estimation repeat the test if an abnormal albumin:creatinine ratio is obtained (in the absence of proteinuria/UTI) at each of the next two clinic visits but within a maximum of 3-4 months take the result to be confirming microalbuminuria if a further specimen (out of two more) is also abnormal (> 2.5 mg/mmol for men, > 3.5 mg/mmol for women) suspect renal disease other than diabetic nephropathy and consider further investigation or referral when the albumin:creatinine ratio (ACR) is raised and any of the following apply: there is no significant or progressive retinopathy blood pressure is particularly high or resistant to treatment person previously had a docum Continue reading >>

Diabetic Nephropathy

Diabetic Nephropathy

Author: Vecihi Batuman, MD, FASN; Chief Editor: Romesh Khardori, MD, PhD, FACP more... Diabetic nephropathy is a clinical syndrome characterized by the following [ 1 ] : Persistent albuminuria (>300 mg/d or >200 g/min) that is confirmed on at least 2 occasions 3-6 months apart Progressive decline in the glomerular filtration rate (GFR) Elevated arterial blood pressure (see Workup) Proteinuria was first recognized in diabetes mellitus in the late 18th century. In the 1930s, Kimmelstiel and Wilson described the classic lesions of nodular glomerulosclerosis in diabetes associated with proteinuria and hypertension. (See Pathophysiology.) 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. (See Epidemiology.) 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. (See Prognosis.) Generally, diabetic nephropathy is considered after a routine urinalysis and screening for microalbuminuria in the setting of diabetes. Patients may have physical findings associated with long-standing diabetes mellitus. (See Clinical Presentation.) Good evidence suggests that early treatment delays or prevents the onset of diabetic nephropathy or diabetic kidney disease. This has consistently been shown in both type1 and type 2 diabetes mellitus. (See Treatment and Management). Regular outpatient follow-up is key in managing diabetic nephropathy successfully. ( Continue reading >>

Proteinuria In Diabetic Nephropathy: Treatment And Evolution

Proteinuria In Diabetic Nephropathy: Treatment And Evolution

, Volume 3, Issue6 , pp 497504 | Cite as Proteinuria in diabetic nephropathy: Treatment and evolution Diabetic nephropathy is characterized by increased urinary albumin excretion and loss of renal function. Increased urinary albumin (proteinuria) is a key component of this disease. Previously, its development led to end-stage renal disease with increased mortality and morbidity for diabetic patients versus nondiabetic patients. Several treatment strategies currently exist that can prevent, slow, and even reverse diabetic nephropathy. New trials suggest that a multidisciplinary approach focused on optimizing metabolic and hypertensive control, in addition to the use of angiotensin-converting enzyme inhibitors or angiotensin 2 receptor antagonists, is effective in halting the progression of disease. Screening and implementation of these strategies is needed to reverse the epidemic of diabetic renal disease. Diabetic PatientProteinuriaDiabetic NephropathyIrbesartanEplerenone These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves. This is a preview of subscription content, log in to check access Unable to display preview. Download preview PDF. US Renal Data System: USRDS 2000 Annual Data Report. Bethesda, MD: The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2000. Google Scholar Collins A, Xue J, Ma J, Louis T: Estimating the number of patients and Medicare costs for end stage renal disease in the US to the year 2010. J Am Soc Nephrol 2000, 11:113A. Google Scholar International Diabetes Federation and International Society of Nephrology Booklet: Diabetes and Kidney Disease, "Time to Act." Brussels: International Diabetes F Continue reading >>

Proteinuria (albuminuria)

Proteinuria (albuminuria)

Proteinuria is where there is too much protein in the urine; a result of damage to the kidneys Proteinuria (albuminuria) is a condition of having too much protein in the urine which results from damage within the kidneys. Proteinuria in diabetes will usually be the result of either long term hyperglycemia (high blood sugar levels) or hypertension (high blood pressure). When the kidneys are working correctly they filter waste products out of the blood but keep in important elements including albumin. Albumin is a protein which helps to prevent water from leaking out of the blood into other tissues. If high blood sugar levels over a number of years damage the kidneys, they may allow too much albumin to be lost from the blood. Proteinuria is a sign therefore that the kidneys have become damaged. The signs of proteinuria will only become noticeable once the kidneys have become very damaged and levels of protein in the urine are high. If this happens, the symptoms may present as swelling of the ankles, hands, tummy or the face. Because the symptoms only occur at a later stage of kidney damage, it is important that as someone with diabetes you are screened for signs of kidney disease at least once a year. The screening involves providing a sample of urine which will be tested by your health team for any abnormal levels of protein. To do this, they compare the ratio of albumin to creatinine. A healthy albumin to creatinine ration is defined as: In diabetes, the main causes of proteinuria are high blood glucose levels over a period of years. High blood pressure can also lead to the development of kidney damage. Pre-eclampsia, a condition which can affect pregnant women, includes very high blood pressure and is another potential cause of protein in the urine. The primary treatm Continue reading >>

Pathogenesis Of The Podocytopathy And Proteinuria In Diabetic Glomerulopathy

Pathogenesis Of The Podocytopathy And Proteinuria In Diabetic Glomerulopathy

Pathogenesis of the Podocytopathy and Proteinuria in Diabetic Glomerulopathy Author(s): Fuad N. Ziyadeh , Gunter Wolf . Faculty of Medicine, American University of Beirut, Beirut, Lebanon. Microalbuminuria is the earliest detectable clinical abnormality in diabetic glomerulopathy. On a molecular level, metabolic pathways activated by hyperglycemia, glycated proteins, hemodynamic factors, and oxidative stress are key players in the genesis of diabetic kidney disease. A variety of growth factors and cytokines are then induced through complex signal transduction pathways. Transforming growth factor-beta 1 (TGF-1) has emerged as an important downstream mediator for the development of renal hypertrophy and the accumulation of mesangial extracellular matrix components, but there is limited evidence to support its role in the development of albuminuria. The loss of proteoglycans in the glomerular basement membrane (GBM) has been recently questioned as causative of the albuminuria, and current research has focused on the podocyte as a central target for the effects of the metabolic milieu in the development and progression of diabetic albuminuria. Podocyte-derived vascular endothelial growth factor (VEGF), a permeability and angiogenic factor whose expression is increased in diabetic kidney disease, is perhaps a major mediator of the increased protein filtration. Decreased podocyte number and/or density as a result of apoptosis or detachment, GBM thickening with altered matrix composition, and a reduction in nephrin protein in the slit diaphragm with podocyte foot process effacement, all comprise the principal features of diabetic podocytopathy that clinically manifests as albuminuria and proteinuria. Many of these events are mediated by angiotensin II whose local concentratio Continue reading >>

Jasn | Mobile

Jasn | Mobile

A large body of evidence shows that elevations of albuminuria, even below the arbitrary threshold for normality of an ACR of 30 mg/g, associate with progression to greater levels of albuminuria, lower estimated GFRs (eGFR) and subsequent decline in renal function, evidence of renal histologic damage, and increased risk of advancing renal failure even after adjustment for confounding risk factors. 1 , 2 One such factor of peculiar importance is arterial BP. Rises in albuminuria accompany increases in BP, initially occurring within the normal range. Higher BP values may precede and predict the development of greater levels of albuminuria, and indeed, the susceptible subset of diabetic subjects who develop albuminuria has a familial predisposition to arterial hypertension. 2 This close association between albuminuria and renal disease is reproduced to a remarkably similar degree in relation to CVD. Even small increases in albuminuria predict an increased risk of CVD morbidity and mortality and all-cause mortality. As for renal disease, the diabetic subject susceptible to nephropathy has a strong familial predisposition to CVD. 2 These clear and consistent epidemiologic associations question whether albuminuria is casually related to DKD and CVD and more importantly, from a clinical standpoint, whether albuminuria is a modifiable risk factor, the treatment or prevention of which would affect the clinical outcome of DKD and CVD. To answer this question, we must revisit the criteria that need to be satisfied to ascribe causality to the variable albuminuria, set them in the context of more recent statistical methodologies for validation of causality, and analyze the relationship of albuminuria separately with renal disease and with CVD. By doing this, we will form a clearer v Continue reading >>

Diabetic Nephropathy: Diagnosis, Prevention, And Treatment

Diabetic Nephropathy: Diagnosis, Prevention, And Treatment

Diabetic nephropathy is the leading cause of kidney disease in patients starting renal replacement therapy and affects ∼40% of type 1 and type 2 diabetic patients. It increases the risk of death, mainly from cardiovascular causes, and is defined by increased urinary albumin excretion (UAE) in the absence of other renal diseases. Diabetic nephropathy is categorized into stages: microalbuminuria (UAE >20 μg/min and ≤199 μg/min) and macroalbuminuria (UAE ≥200 μg/min). Hyperglycemia, increased blood pressure levels, and genetic predisposition are the main risk factors for the development of diabetic nephropathy. Elevated serum lipids, smoking habits, and the amount and origin of dietary protein also seem to play a role as risk factors. Screening for microalbuminuria should be performed yearly, starting 5 years after diagnosis in type 1 diabetes or earlier in the presence of puberty or poor metabolic control. In patients with type 2 diabetes, screening should be performed at diagnosis and yearly thereafter. Patients with micro- and macroalbuminuria should undergo an evaluation regarding the presence of comorbid associations, especially retinopathy and macrovascular disease. Achieving the best metabolic control (A1c <7%), treating hypertension (<130/80 mmHg or <125/75 mmHg if proteinuria >1.0 g/24 h and increased serum creatinine), using drugs with blockade effect on the renin-angiotensin-aldosterone system, and treating dyslipidemia (LDL cholesterol <100 mg/dl) are effective strategies for preventing the development of microalbuminuria, in delaying the progression to more advanced stages of nephropathy and in reducing cardiovascular mortality in patients with type 1 and type 2 diabetes. DEFINITION AND EPIDEMIOLOGY Diabetic nephropathy is the leading cause of chronic Continue reading >>

Diabetes Mellitus Type 2 And Proteinuria

Diabetes Mellitus Type 2 And Proteinuria

1. Introduction Worldwide the prevalence of diabetes was estimated to be 2.8% in 2000 and 4.4% in 2030. The total number of people with diabetes is projected to rise from 171 million in 2000 to 366 million in 2030 [1]. The spread will be higher in developing countries (69%) compared to developed countries (20%). Most of diabetic patients will have type 2 diabetes [2]. Chronic kidney disease (CKD) is prevalent in people with diabetes; a recent analysis of NHANES data found that 39.6% of people with diagnosed diabetes, 41.7% of those with undiagnosed diabetes and 17.7% of those with prediabetes had CKD [3]. Increased urinary protein excretion may be an early clinical manifestation of diabetic nephropathy. However, when assessing protein excretion, the urine dipstick is a relatively insensitive marker for initial increases in protein excretion, not becoming positive until protein excretion exceeds 300 to 500 mg/day (upper limit of normal less than 150 mg/day, with most individuals excreting less than 100 mg/day) [4]. Microalbuminuria is delimited as an albumin excretion rate of 30-300 mg/24 h or a spot urine albumin to creatinine Ratio (ACR) of 30-300 mg/g (3.5-35 mg/mmol) in males and 20-200 mg/g (2.5-25 mg/mmol) in females. Overt diabetic nephropathy (DN) is settled by proteinuria >500 mg/24 h or albuminuria >300 mg/24 h. Also DN can be defined by an estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 m2 [5]. 5097 subjects with type 2 diabetes were followed from 1977 to 1997 to determine the rate of progression of kidney disease. From diagnosis of diabetes, progression to microalbuminuria occurred at 2.0% per year, from microalbuminuria to macroalbuminuria at 2.8% per year, and from macroalbuminuria to elevated plasma creatinine (>or=175 micromol/L) or r Continue reading >>

Proteinuria In Diabetic Patients--is It Always Diabetic Nephropathy?

Proteinuria In Diabetic Patients--is It Always Diabetic Nephropathy?

Kidney Blood Press Res. 2006;29(1):48-53. Epub 2006 Apr 20. Proteinuria in diabetic patients--is it always diabetic nephropathy? Medical Clinic A, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany. [email protected] Diabetic nephropathy (dNP) is a consequence of type 1 and type 2 diabetes, typically occurring between 5 and 15 years after diabetes has been diagnosed. The coincidence of dNP and diabetic retinopathy (dRP) is well known. In this study we correlated the histological findings of the kidney biopsy with the clinically expected diagnosis of dNP. Over a 4-year period with a total of 326 kidney biopsies, 85 biopsies were performed on patients with diabetes. In all of these patients we had information about duration of diabetes and ophthalmological status. Additionally, data about proteinuria, urine sediment and autoantibodies were available. The nephrologist had to give the suspected diagnosis before the biopsy was performed, using the clinical data available. In 57 patients (67%) dNP was predicted clinically before biopsy. In 28 patients we expected a different kind of kidney disease. Only 43 patients had dNP histologically. In 16 out of 19 patients with dRP we also found dNP. 26 patients with dNP did not have dRP. So dRP was very specific but not sensitive to predict dNP. On the other hand, all patients without dRP but acanthocytes in urine sediment had non-diabetic kidney disease (NDKD). In the case of patients with neither dRP nor acanthocytes, it was very difficult to distinguish between dNP and NDKD. Acanthocytes and antineutrophil cytoplasmatic antibodies with positive antibodies for proteinase 3 or myeloperoxidase were found only in NDKD, but ANAs were detected in a wide titer range in dNP and NDKD. The known duration of the diabetes ranged from 1 to Continue reading >>

Proteinuria - Diabetes Self-management

Proteinuria - Diabetes Self-management

The presence of protein in the urine, an early sign of kidney disease. One of the major medical complications of diabetes is diabetic nephropathy , a type of kidney disease that develops slowly over the course of years. Diabetic nephropathy can lead to end-stage renal disease (kidney failure), necessitating dialysis or kidney transplantation. In fact, diabetic nephropathy is the leading cause of kidney failure in the United States. Normally, the kidneys work to filter waste products, water, and other chemicals from the blood and send them to the bladder where they are excreted in the form of urine. In the earliest stage of diabetic nephropathy, abnormally large amounts of blood flow through the nephrons, the tiny filters within the kidneys. This condition is known as hyperfiltration. After years of hyperfiltration, increased amounts of proteins, which ordinarily remain in the bloodstream, may begin to leak into the urine. One such protein is albumin . Between 4% and 15% of adults with diabetes have small amounts of albumin leaking into their urine, a condition known as microalbuminuria. Since it can progress to kidney disease, it is important to detect microalbuminuria as early as possible. Microalbuminuria can only be detected by special tests that became available within the past 20 years; it cannot be picked up by standard urine tests. If the injury to the blood filters gets worse, larger amounts of albumin may begin to leak into the urine. This stage is called clinical albuminuria or clinical nephropathy. Because so much albumin is lost in the urine, the level of albumin in the blood falls below the normal range. Albumin is needed for blood to hold water inside the arteries and capillaries. When theres not enough albumin, water can accumulate in the tissues, causin Continue reading >>

Diabetic Nephropathy—the Family Physician's Role

Diabetic Nephropathy—the Family Physician's Role

Nearly one-half of persons with chronic kidney disease have diabetes mellitus. Diabetes accounted for 44 percent of new cases of kidney failure in 2008. Diabetic nephropathy, also called diabetic kidney disease, is associated with significant macrovascular risk, and is the leading cause of kidney failure in the United States. Diabetic nephropathy usually manifests after 10 years' duration of type 1 diabetes, but may be present at diagnosis of type 2 diabetes. Screening for microalbuminuria should be initiated five years after diagnosis of type 1 diabetes and at diagnosis of type 2 diabetes. Screening for microalbuminuria with a spot urine albumin/creatinine ratio identifies the early stages of nephropathy. Positive results on two of three tests (30 to 300 mg of albumin per g of creatinine) in a six-month period meet the diagnostic criteria for diabetic nephropathy. Because diabetic nephropathy may also manifest as a decreased glomerular filtration rate or an increased serum creatinine level, these tests should be included in annual monitoring. Preventive measures include using an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker in normotensive persons. Optimizing glycemic control and using an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker to control blood pressure slow the progression of diabetic nephropathy, but implementing intensive glycemic and blood pressure control is associated with more adverse outcomes. Low-protein diets may also decrease adverse renal outcomes and mortality in persons with diabetic nephropathy. Diabetic nephropathy (also called diabetic kidney disease) is the leading cause of kidney failure in the United States. According to the Centers for Disease Control and Prevention, in 2008, approxima Continue reading >>

Diabetic Nephropathy: The Proteinuria Hypothesis

Diabetic Nephropathy: The Proteinuria Hypothesis

Diabetic Nephropathy: The Proteinuria Hypothesis Tel. +1 617 732 2477, Fax +1 617 732 2467 Background/Aims: Proteinuria, nearly a universal finding in progressive kidney disease, has been the subject of frequent recent analyses in the renal literature. Proteinuria is a hallmark of diabetic nephropathy: microalbuminuria is the principal early predictor for progression of diabetic glomerulopathy, and proteinuria may be viewed as a measure of the severity and promoter of progression of nephropathy. Methods: This article critically reviews for the first time the full scope of diabetic proteinuria complex molecular mechanisms, natural history, and analysis of treatment trials in order to address the validity of the proteinuria hypothesis, i.e., that diabetic proteinuria is a modifiable determinant of renal progression. This hypothesis is analyzed in detail, including recent studies on the primary therapy of diabetic nephropathy, renin-angiotensin blockade. Results: As fully developed, this hypothesis consists of three postulates: that higher amounts of proteinuria predict progressive loss of function, that proteinuria reduction correlates with slowing progression, and that proteinuria is a surrogate endpoint for clinical trials. The latter postulate has not before been adequately linked to growing information about the first two postulates as they apply to diabetic kidney disease. Conclusion: While diabetic nephropathy is a disease model for the potential use of proteinuria as a surrogate marker for renal progression, this shift in perspective will require prospective data from additional clinical trials, particularly of non-renin-angiotensin blocking drugs, to be complete. Diabetic kidney disease is characterized by excessive urinary albumin excretion followed by loss of k Continue reading >>

Protein In Urine (proteinuria)

Protein In Urine (proteinuria)

People with proteinuria have urine containing an abnormal amount of protein. The condition is often a sign of kidney disease. Healthy kidneys do not allow a significant amount of protein to pass through their filters. But filters damaged by kidney disease may let proteins such as albumin leak from the blood into the urine. Proteinuria can also be a result of overproduction of proteins by the body. Kidney disease often has no early symptoms. One of its first signs may be proteinuria that's discovered by a urine test done during a routine physical exam. Blood tests will then be done to see how well the kidneys are working. The two most common risk factors for proteinuria are: Both diabetes and high blood pressure can cause damage to the kidneys, which leads to proteinuria. Other types of kidney disease unrelated to diabetes or high blood pressure can also cause protein to leak into the urine. Examples of other causes include: Increased production of proteins in the body can lead to proteinuria. Examples include multiple myeloma and amyloidosis. Other risk factors include: Age over 65 Family history of kidney disease Preeclampsia (high blood pressure and proteinuria in pregnancy) Race and ethnicity: African-Americans, Native Americans, Hispanics, and Pacific Islanders are more likely than whites to have high blood pressure and develop kidney disease and proteinuria. Some people get more protein into urine while standing than while lying down. That is known as orthostatic proteinuria. Proteinuria is not a specific disease. So its treatment depends on identifying and managing its underlying cause. If that cause is kidney disease, appropriate medical management is essential. Untreated chronic kidney disease can lead to kidney failure. In mild or temporary proteinuria, no trea Continue reading >>

The Management Of Diabetic Proteinuria. Which Antihypertensive Agent?

The Management Of Diabetic Proteinuria. Which Antihypertensive Agent?

The management of diabetic proteinuria. Which antihypertensive agent? (1)Department of Medicine, Repatriation General Hospital, University of Melbourne, Victoria, Australia. Diabetic renal disease is a clinical syndrome in which proteinuria is followed bythe development of renal failure, and is commonly associated with the concomitantdevelopment of hypertension. In insulin-dependent diabetic (IDDM) patients,hypertension often first appears in the microalbuminuric phase of diabeticnephropathy whereas in non-insulin-dependent diabetic (NIDDM) patients,hypertension often antecedes nephropathy and may precede the diagnosis ofdiabetes. Antihypertensive regimens including diuretics, vasodilators such ashydralazine, beta-blockers and ACE inhibitors reduce proteinuria and delay thedecline in renal function in IDDM patients with established nephropathy. No such data are as yet available for calcium antagonists. In microalbuminuric diabeticpatients with hypertension, conventional antihypertensive agents, ACE inhibitors and calcium antagonists have been shown to decrease urinary albumin excretion. Inthe diabetic patient with normal blood pressure and microalbuminuria, there ismuch less information. It appears likely that ACE inhibitors reduce or retard therate of increase in albuminuria in these patients. The effect on ultimatelydelaying or preventing renal failure remains unknown although the preliminaryevidence is encouraging. Data on calcium antagonists remain inconclusive withsome reports suggesting an increase in proteinuria with the dihydropyridinecalcium antagonists. However, a recent longer term study suggested thatnifedipine may prevent the rise in albuminuria which is generally observed in theuntreated normotensive microalbuminuric subject. Continue reading >>

Addition Of Nonalbumin Proteinuria To Albuminuria Improves Prediction Of Type 2 Diabetic Nephropathy Progression

Addition Of Nonalbumin Proteinuria To Albuminuria Improves Prediction Of Type 2 Diabetic Nephropathy Progression

Albuminuria is generally accepted as a sensitive marker of diabetic nephropathy but has limitations in predicting its progression. The aim of this study was to evaluate the use of nonalbumin proteinuria in addition to albuminuria for predicting the progression of type 2 diabetic nephropathy. In this retrospective observational study, the urine albumin-to-creatinine ratio (ACR) and the nonalbumin protein-to-creatinine ratio (NAPCR) were measured in 325 patients with type 2 diabetes and estimated glomerular filtration rates (eGFR) 30mL/min/1.73m2. The patients were divided into four groups based on the cutoff points for the urinary ACR (30mg/g) and NAPCR (120mg/g). The renal outcomes were chronic kidney disease (CKD) progression and accelerated eGFR decline. During the 4.3-year follow-up period, 25 (7.7%) patients showed CKD progression and 69 (21.2%) patients showed accelerated eGFR decline. After adjusting for nine clinical parameters, the group with a NAPCR greater than 120mg/g exhibited higher cumulative incidences of CKD progression (hazard ratio 6.84; P=0.001) and accelerated eGFR decline (hazard ratio 1.95; P=0.011) than the group with a NAPCR<120mg/g. In patients with normoalbuminuria, the group with NAPCR levels greater than 120mg/g also exhibited a higher cumulative incidence than that with NAPCR levels <120mg/g of CKD progression (hazard ratio 21.82; P=0.005). The addition of NAPCR to ACR improved the model fit for CKD progression and accelerated eGFR decline. Nonalbumin proteinuria showed additional value over and above that of albuminuria for predicting the progression of CKD in patients with type 2 diabetes. The prevalence of diabetes is increasing, and diabetic nephropathy develops in 2040% of diabetic patients [ 1 , 2 ]. Type 2 diabetes is the major cause Continue reading >>

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