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Diabetic Nephropathy Diagnosis

By  , Expert Content
Dec 22, 2011
4.8 / 5(4 Ratings)

The term nephropathy indicates kidney disease or damage i.e. damage to the kidneys caused by diabetes. Diabetic nephropathy is a common complication of diabetes. A person with diabetes is considered to have diabetic nephropathy when more than 300 mg of protein is present in the urine per 24 hours.


Urine Dipstick test: It is usually used as an initial screening test for all the patients with diabetes for the presence of protein (albumin) in urine. It is a simple and easy to do test, which can detect small amounts of protein in the urine (microalbuminuria). The strip changes colour if the protein is present. The strip is colour coded and it gives an estimate of the amount of protein. If the urine dipstick test shows protein uria, further tests for microalbuminuria and tests to quantitate protein in urine are done.


Tests for microalbuminuria: Presence of small amounts of protein (albumin) in the urine (microalbuminuria) is the first sign of kidney disease in diabetes. With decline in kidney function, the amount of albumin in urine increases and microalbuminuria becomes overt protein uria. Microalbumin urine tests allow detection of very small amounts of protein in the urine, which are often not detected by a routine urine test. Screening for microalbuminuria helps to identify kidney disease in the early stages. Early diagnosis and appropriate Interventions at this time are more effective (it can prevent further damage to the kidneys) than in the later stages.


Screening for microalbuminuria or diabetic nephropathy is done in a urine sample. Screening for microalbuminuria can be carried out in the urine sample by way of the following:

  • Timed urine collections over a 24-hour period.
  • Urine collected for 4 hours or overnight.
  • Random 'spot-urine' sample.

Your doctor will recommend the test that should be done and will advise you on how frequently you should take the test for microalbuminuria or diabetic nephropathy.


Imaging Studies: Renal ultrasound is done to assess the size of the kidney. This is a painless and non-invasive test for the evaluation of kidney. The test uses high-frequency sound waves (which cannot be heard by human ears) to evaluate structures inside the body. The pattern of the echoes produced when the sound waves are reflected from the internal structure creates a picture called a sonogram. The radiologist can differentiate healthy tissues and abnormal pattern on this picture. When ultrasound test is done to look at the kidney, an image of the kidney and other structures inside the abdomen is formed. In the early stages of diabetic nephropathy, kidney appears enlarged from hyper filtration. As the kidney damage progresses, the size of kidney becomes smaller.


Some other tests that are done regularly to check your kidneys are:

  • Serum Creatinine: Creatinine is a substance present in the blood. Blood test to determine Creatinine levels shows how well your kidneys are working.
  • Blood pressure: It should be checked regularly, both at home and by your doctor as rise in blood pressure increases the risk of kidney damage. Apart from this, the blood pressure rises as kidney damage progresses.

Kidney biopsy: If your doctor suspects that diabetes is not the cause of your kidney disease, other blood and urine tests as well as kidney biopsy may be done. A small sample of kidney tissue may be removed and examined in the lab.


These are some tests that are done in person with diabetes who may have suspected or confirmed kidney disease. Your doctor may recommend other tests such as estimated GFR (glomerular filtration rate), blood levels of phosphorus, calcium, bicarbonate, PTH and potassium; haemoglobin and hematocrit as required.

 

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Comments
  • jawed09 Sep 2011
    how important is creatinine monitoring.