Screening For Diabetic Nephropathy Research Articles

330 Investigating Adherence to Diabetic Nephropathy Screening and Management in a Value-Based Primary Care Setting: A Call to Action

330 Investigating Adherence to Diabetic Nephropathy Screening and Management in a Value-Based Primary Care Setting: A Call to Action

Physicians' Practices in Diabetic Nephropathy in Primary Healthcare Centers in Jazan City, Saudi Arabia, 2023.

Background and Objectives: Diabetes is one of the most common diseases dealt with by physicians in primary healthcare centers (PHCs). The disease is associated with macrovascular and microvascular complications, especially in those with long disease duration and uncontrolled diabetic nephropathy, which is one of the most common microvascular complications among diabetic patients. This investigation assessed the practices of physicians working at PHCs in terms of diabetic nephropathy screening, management, and referral. Materials and Methods: This study is a cross-sectional investigation targeting physicians working at PHCs in the Jazan region of Saudi Arabia between March and August of 2023. Data were collected via a self-administered questionnaire, which was distributed via online platforms. The questionnaire included sections measuring physicians' demographic data and associated factors regarding training, the availability of resources, and practices in diabetic nephropathy, including screening, management, and referral. Chi-squared tests were used to assess associations between the practices of physicians and the measured demographics. Result: A total of 234 physicians participated in the investigation. The median age of the participants was 35 years. The adherence level of practice toward diabetic nephropathy according to American Diabetes Association (ADA) guidelines ranged from 40 points (the highest adherence level of participants) to 19 points (the lowest adherence level of participants), with a median of 33 points. Higher adherence levels were noted among physicians in Saudi Arabia, physicians with higher education levels, physicians specializing as family physicians or diabetologists, physicians who reported attending online and on-site training at diabetic centers, physicians who reported continuous access to urine and serum creatinine tests, and physicians who reported continuous access to the American Diabetes Association guidelines (p < 0.05). Conclusions: There are several factors associated with the level of adherence in diabetic nephropathy practice, such as physicians' education level, specialty, training, and access to guidelines. The findings suggest the need for more training for PHC physicians in the care of patients affected by or at risk of diabetic nephropathy.

Age at onset of type 1 diabetes between puberty and 30 years old is associated with increased diabetic nephropathy risk

Diabetic nephropathy is a critical complication of patients with type 1 diabetes, while epidemiological studies were scarce among Asian countries. We conducted a cross-sectional study to identify factors associated with diabetic nephropathy by questionnaires, using student’s t-test, chi-square test, and multivariable logistic regression. Among 898 participants, 16.7% had diabetic nephropathy. Compared with non-diabetic nephropathy patients, the patients with diabetic nephropathy had significantly higher percentage with onset age of type 1 diabetes between puberty and under 30 years old (female ≥ 12 or male ≥ 13 years old to 29 years old), longer diabetes duration, having family history of diabetes and diabetic nephropathy, accompanied with hypertension, hyperlipidemia, or coronary artery disease (CAD). Compared with patients with onset age before puberty, the odds of diabetic nephropathy occurrence increased to 1.61 times in patients with onset age between puberty and under 30 years old (p = 0.012) after adjusting diabetes duration. Age of diabetes onset between puberty and under 30 years old, diabetes duration, HbA1c, hospital admission within 3 years, diabetic retinopathy, hypertension, systolic blood pressure (SBP), triglyceride levels, and use of angiotensin converting enzyme inhibitor (ACEI) and/or angiotensin receptor blockers (ARB) were independent factors associated with diabetic nephropathy Screening for proteinuria is important in daily clinical practice and should be part of diabetes self-management education for patients with type 1 diabetes.

Guideline-level monitoring, biomarker levels and pharmacological treatment in migrants and native Danes with type 2 diabetes: Population-wide analyses.

The prevalence of type 2 diabetes (T2D) is higher in migrants compared to native populations in many countries, but the evidence on disparities in T2D care in migrants is inconsistent. Therefore, this study aimed to examine this in Denmark. In a cross-sectional, register-based study on 254,097 individuals with T2D, 11 indicators of guideline-level care were analysed: a) monitoring: hemoglobin-A1c (HbA1c), low-density lipoprotein cholesterol (LDL-C), screening for diabetic nephropathy, retinopathy, and foot disease, b) biomarker control: HbA1c and LDL-C levels, and c) pharmacological treatment: glucose-lowering drugs (GLD), lipid-lowering drugs, angiotensin-converting enzyme-inhibitors/angiotensin receptor blockers, and antiplatelet therapy. Migrants were grouped by countries of origin: Middle East, Europe, Turkey, Former Yugoslavia, Pakistan, Sri Lanka, Somalia, Vietnam. In all migrant groups except the Europe-group, T2D was more prevalent than in native Danes (crude relative risk (RR) from 0.62 [0.61-0.64] (Europe) to 3.98 [3.82-4.14] (Sri Lanka)). In eight indicators, non-fulfillment was common (>25% among native Danes). Apart from monitoring in the Sri Lanka-group, migrants were at similar or higher risk of non-fulfillment than native Danes across all indicators of monitoring and biomarker control (RR from 0.64 [0.51-0.80] (HbA1c monitoring, Sri Lanka) to 1.78 [1.67-1.90] (LDL-C control, Somalia)), while no overall pattern was observed for pharmacological treatment (RR from 0.61 [0.46-0.80] (GLD, Sri Lanka) to 1.67 [1.34-2.09] (GLD, Somalia)). Care was poorest in migrants from Somalia, who had increased risk in all eleven indicators, and the highest risk in nine. Adjusted risks were elevated in some migrant groups, particularly in indicators of biomarker control (fully-adjusted RR from 0.84 [0.75-0.94] (LDL-C levels, Vietnam) to 1.44 [1.35-1.54] (LDL-C levels, Somalia)). In most migrant groups, T2D was more prevalent, and monitoring and biomarker control was inferior compared to native Danes. Migrants from Somalia received the poorest care overall, and had exceedingly high lipid levels.

Screening for Chronic Kidney Disease in Type 2 Diabetic Patients: Single Centre Study

Abstract Background Diabetes mellitus is the most common cause of chronic kidney disease in the world, leading to multiple complications including end-stage renal disease, cardiovascular disease and even death so, Screening is an important strategy to address the burden of CKD in diabetic population. International clinical guidelines recommend CKD screening for individuals with risk factors such as diabetes, using laboratory assessments of glomerular filtration rate (GFR) and urine albumin excretion. Objective This study describes the implementation and outcomes of screening programme for chronic kidney disease in type 2 diabetic patients to assess the burden of renal disease in diabetic population. Patients and Methods The present study included two hundred type 2 diabetic patients complicated with diabetic nephropathy. Fifty five percent of the studied patients were males. Age ranged from 42 to 82 years with mean ± SD of 60.09 ± 8.55 years. They were screened in Alagouza Hospital for CKD by using urinary ACR and average eGFR. Patients with CKD were further investigated for extrarenal diabetic complications as PVD, amputation and cardiovascular complications by using LL arterial duplex and echocardiography. Results As regard diabetic complications, nephropathy came in the 1st rank with 106 patients (53%) presented with either average eGFR&amp;lt;60 ml/min/1.73 m2(10.5%), ACR &amp;gt;30 mg albumin/gm creatinine (30%) or both(12.5%). That was followed by history of neuropathy which represented 44.5% of the studied patients. Retinopathy evidenced in fundus examination compromised about 34.516% out of our studied population. Patients with past history of stroke represented 17.5% of the studied population Peripheral neuropathy was more common in patients with nephropathy 69.7 % (n = 62) (4 patients with decline eGFR, 36 patients with albuminuria and 22 patients with both), compared to only 30.3 % (n = 27) non- nephropathic diabetic patients gave positive history of neuropathy. retinopathy was more common in patients with nephropathy (11 patients with declined GFR, 25 patients with albuminuria and 25 patients with albuminuria and declined GFR), versus only 8 patients in among the non-nephropathic diabetic patients had retinopathy evidenced in fundus examination. Stroke was more common among patients with nephropathy (4 patients with decline eGFR, 6 patients with albuminuria and 12 patients with albuminuria and declined eGFR), versus 13 patients with positive stroke history in non- nephropathic diabetic patients. Patients with nephropathy were further investigated for the presence of extra renal diabetic complications as PVD and cardiovascular complications. Arterial LL duplex revealed PVD in 32.1% (34 patients) with 3 patients underwent amputation. As regard cardiovascular complications, 17.9 % (19 patients) were found to have abnormal findings in echocardiography examination including heart failure and ischemic changes. Conclusion From our study, we showed the high burden of diabetic complications among the patients with type 2 diabetes especially renal diabetic complications. Therefore, screening of diabetic nephropathy in patients with type 2 diabetes mellitus can help in early treatment and avoid its more serious complications not only the progression to ESRD but also development of other extra-renal diabetic complications.

Фактори ризику, асоційовані з діабетичною нефропатією та їх клінічне значення

The purpose of the study was to highlight the most studied risk factors associated with the development and/or progression of diabetic nephropathy, with an emphasis on some important aspects that should be kept in mind by the physician. Materials and methods. Research materials are publications of national and foreign authors. The methods used were: system approach and system theoretical retrospective analysis of selected materials; generalization; medical and statistical method. Results and discussion. Timely diagnostics of diabetic nephropathy and elimination of risk factors of its development and progression are emphasized to be a difficult task of clinics of internal diseases particularly in conditions when amount of these risk factors is constantly growing. The most investigated risk factors associated with development and progression of diabetic nephropathy such as age, arterial hypertension, disorders of carbohydrate and lipid exchange, proteinuria are discussed in the article. Some peculiarities of correction of metabolic risk factors such as hyperglycemia and dyslipidemia as well as hemodynamic risk factors such as arterial hypertension and intraglomerular hypertension participated in development and progression of diabetic nephropathy are discussed with consideration of acting recommendations. Some aged and gender peculiarities of change of glomerular filtration rate as well as a role of arterial hypertension in progression of diabetic nephropathy through albuminuria are considered. A significance of glycosylated hemoglobin level as an independent risk factors of microalbuminuria is demonstrated. A role of secondary lipid exchange disorders due to type 2 diabetes mellitus in reduction of glomerular filtration rate and elevation of albumin/creatinine ratio as well as albuminuria presence is emphasized. A necessity of urinal detection of nephrin and podocin levels for an early diagnostics of diabetic nephropathy and monitoring of renal glomerular dysfunction in diabetes mellitus is discussed. Some risk factors related to appearance of albuminuria as well as association of albuminuria and proteinuria with glomerular and tubular structural changes in kidney are considered. A clinical significance of albumin/creatinine ratio calculation as an alternative to daily urinal protein concentration measuring for diabetic nephropathy screening is emphasized. Some risk factors related to close positive correlation with this ratio are considered. A role of genetic factors in the development of diabetic nephropathy with a participation of known today some genes candidates and a necessity of genealogical anamnesis definition to reveal a patient’s susceptibility to development of diabetic nephropathy is discussed. Conclusion. The contemporary recommendations for control of glycemia, correction of dyslipidemia and arterial hypertension which allow significantly reduce a risk of kidney impairment in diabetes mellitus or inhibit a progression of diabetic nephropathy in patients with albuminuria and proteinuria are given. A significance of detailed investigation of principles of development and progression of diabetic nephropathy for collaboration of effective diagnostic, treatment and preventive measures is emphasized

A Project work on Recent approches in the Treatment of Diabetic Nepheropathy

Renal failure is a common long-torm complication of diabetes mellitus. Stages of diabetic nephropathy have been described that characterize its clinical course. Diabetic nephropathy develops secondary to long- changes that damage the glomeruli’s. Therapy that focuses on the control of glomerular pressures and systemic hypertension can slow the progression of proteinuria and deterioration of renal function. Angiotensin converting enzyme (ACE) inhibitors and calcium channel blockers have been demonstrated to be effective in the management of diabetic nephropathy. A systematic approach to the patient with diabetes with help identify those individuals early in the course of disease when proper therapy may be most helpful. Diabetic nephropathy is the leading cause of chronic renal disease and a major cause of cardiovascular mortality. Diabetic nephropathy has been categorized into stages: micro albuminuria and macro albuminuria. The cut-off values of micro- and macro albuminuria are arbitrary and their values have been questioned. Subjects in the upper-normal range of albuminuria seem to be at high risk of progression to micro- or macro albuminuria and they also had a higher blood pressure than normoalbuminuric subjects in the lower norm albuminuria range. Diabetic nephropathy screening is made by measuring albumin in spot urine. If abnormal, it should be confirmed in two out three samples collected in a three to six-months interval. Additionally, it is recommended that glomerular filtration rate be routinely estimated for appropriate screening of nephropathy, because some patients present a decreased glomerular filtration rate when urine albumin values are in the normal range. The two main risk factors for diabetic nephropathy are hyperglycemia and arterial hypertension, but the genetic susceptibility in both type 1 and type 2 diabetes is of great importance. Other risk factors are smoking, dyslipidemia, proteinuria, glomerular hyper filtration and dietary factors. Nephropathy is pathologically characterized in individuals with type 1 diabetes by thickening of glomerular and tubular basal membranes, with progressive meningeal expansion (diffuse or nodular) leading to progressive reduction of glomerular filtration surface. Concurrent interstitial morphological alterations and hyalinization of afferent and efferent glomerular arterioles also occur. Podocytes abnormalities also appear to be involved in the glomerulosclerosis process. In patients with type 2 diabetes, renal lesions are heterogeneous and more complex than in individuals with type 1 diabetes. Treatment of diabetic nephropathy is based on a multiple risk factor approach, and the goal is retarding the development or progression of the disease and to decrease the subject's increased risk of cardiovascular disease. Achieving the best metabolic control, treating hypertension (&lt;130/80 mmHg) and dyslipidemia (LDL cholesterol &lt;100 mg/dl), using drugs that block the renin-angiotensin-aldosterone system, are effective strategies for preventing the development of micro albuminuria, delaying the progression to more advanced stages of nephropathy and reducing cardiovascular mortality in patients with diabetes.

Getting Ahead: A Resident Led Quality Improvement Project to Increase Diabetic Nephropathy Screening in an Underserved Hispanic-Predominant Population.

Diabetes is the leading cause of end-stage renal disease (ESRD) in the United States (US), with 37 million having chronic kidney disease. Despite national guidelines recommendations for diabetic nephropathy screening with urine albumin-to-creatinine ratio (UACR), less than 50% receive full screening.Our Internal Medicine residents led a quality improvement project to increase diabetic nephropathy screening rate with UACR in our resident clinic by 50% in one academic year. We conducted the resident-led quality improvement project from July 2021 to April 2022. We reviewed the electronic medical records (EMR) from our clinic pre-intervention July 2020 to June 2021 and compared this to post intervention July 2021 to March 2022 determining the nephropathy screening rates in patients with diabetes. Our interventions included resident education, pre and post surveys to test foundational knowledge, adding UACR in the affordable laboratory order form and establishing normal reference range of UACR in the EMR. We collected 217 patients with diabetes, 27% were uninsured, 38% had Medicare/Medicaid and 90% identified as Hispanic. Comparing pre to post intervention, there was a significant change of 45 (20.7%) vs 71 (32.7%) patients screened for diabetic nephropathy with a UACR. The correct average score of knowledge-based questions was 82% on the pre survey, which increased to 88% in the post survey. Our study showed promising results on improving diabetic nephropathy screening. The comprehensive approach including resident education about diabetic nephropathy screening with UACR and more so facilitating the order set in the EMR were key to achieve this goal.

Application of Cys C and UmAlbUCr Test in the Early Screening of Diabetic Nephropathy

Application of Cys C and UmAlbUCr Test in the Early Screening of Diabetic Nephropathy

Assessment of sublingual microcirculation for the screening of diabetic nephropathy

ObjectiveTo investigate the potential of employing sublingual microcirculation as an early noninvasive screening technique for diabetic nephropathy (DN).Research design and methodsWe recruited 89 patients with type 2 diabetes mellitus (T2DM) and 41 healthy subjects in this cross-sectional observational study. All participants underwent fluorescein fundus angiography, vibration perception testing, 10 g (Semmes–Weinstein) monofilament examination, nerve conduction velocity, and 24-h urine microalbumin determination. HbA1c, fasting plasma glucose, blood lipid, and estimated glomerular filtration rate(eGFR) were measured. Sublingual microcirculatory images were captured using side-stream dark-field (SDF) microcirculation microscopy, and total and perfused vascular density (TVD and PVD) were calculated.ResultsThe sublingual microcirculatory parameters denoting microvascular density and perfusion were negatively correlated with both fasting plasma glucose (TVD, r = − 0.316, P < 0.001; PVD, r = − 0.350, P < 0.001; PPV, r = − 0.279, P = 0.001) and HbA1c (TVD, r = − 0.367, P < 0.001; PVD, r = − 0.423, P < 0.001; PPV, r = − 0.399, P < 0.001). Diabetes patients already had a reduction in sublingual microcirculation compared with healthy control, and more severe reductions in TVD (7.07 ± 1.64 vs. 9.67 ± 1.94 mm/mm2, P < 0.001) and PVD (5.88 ± 1.82 vs. 8.64 ± 2.46 mm/mm2, P < 0.001) were found in those diabetes patients developed microvascular complications. Sublingual microcirculation impairment was accompanied with higher urinary albumin creatinine ratio (UACR). Receiver operating characteristic (ROC) analysis showed that TVD (area under the curve, AUC = 0.890 [0.836 0.944], P < 0.001) and PVD (AUC = 0.883 [0.826, 0.940], P < 0.001) could be indicators for DN screening. We derived a combined predictor index (CPI) considering both TVD and PVD for screening DN, and both the AUC (0.892, [0.838 0.945], P < 0.001) and cutoff point of 11.30 mm/mm2 showed great improvement (sensitivity: 95.5%, specificity: 67.4%).ConclusionsDiabetes patients experienced impaired sublingual microcirculation, which was closely correlated with UACR. Sublingual microcirculation monitoring could be used for the noninvasive early detection of DN.

Screening for Diabetes Complications during the COVID-19 Outbreak in South Korea

This study aimed to investigate the implementation of diabetes complications screening in South Korea during the coronavirus disease (COVID-19) outbreak. Data from the Korea Community Health Surveys conducted in 2019 and 2020 were used. This study included 51,471 participants. Multiple level analysis was used to investigate the relationships between screening for diabetic retinopathy and diabetic nephropathy and variables of both individual- and community-level factors in 2019 and 2020, before and after the COVID-19 outbreak. Diabetes nephropathy complications screening in 2020 had a lower odds ratio. However, regions heavily affected by COVID-19 showed a negative association with diabetes complications screening after the COVID-19 outbreak. For those being treated with medication for diabetes, there was a significant negative association with diabetic nephropathy screening after the outbreak. The COVID-19 outbreak was associated with a reduction in the use of diabetes nephropathy complications screening. Additionally, only regions heavily affected by COVID-19 spread showed a negative association with diabetes complications screening compared to before the COVID-19 outbreak. In this regard, it appears that many patients were unable to attend outpatient care due to COVID-19. As such, these patients should be encouraged to visit clinics for diabetes complications screening. Furthermore, alternative methods need to be developed to support these patients. Through these efforts, the development of diabetes-related complications should be prevented, and the costs associated with these complications will be reduced.

Screening for chronic kidney disease in Egyptian type 2 diabetic patients: a single-center study

Background Screening is an important strategy to address the burden of chronic kidney disease (CKD) in diabetic population. International clinical guidelines recommend CKD screening for individuals with risk factors such as diabetes using laboratory assessments of glomerular filtration rate (GFR) and urine albumin excretion. To assess the implementation and outcomes of screening programs for CKD in type 2 diabetic patients.Patients and methods A cross-sectional study was conducted that included 200 adult type 2 diabetic patients in Alagouza Hospital. Patients on hemodialysis and those with type 1 diabetes mellitus were excluded. Patients were screened for CKD using urinary albumin/creatinine ratio and average estimated glomerular filtration rate. Patients with CKD were further investigated for extrarenal diabetic complications such as peripheral vascular disease and cardiovascular complications.Results Overall, 55% of the studied patients were males, with a mean age of 60.09±8.55 years. Among diabetic complications, nephropathy was the most common (53%), followed by history of neuropathy (44.5%), and retinopathy evidenced in fundus examination (34.516%). History of stroke presented in 17.5% of patients. Peripheral neuropathy, retinopathy, and stroke history were more common in nephropathic patients compared with patients without nephropathy (62/27, 61/8, and 22/13, respectively). Patients with evidenced nephropathy who were further investigated for extrarenal diabetic complications showed peripheral vascular disease in 32.1% (34 patients), with three patients undergoing amputation. Heart failure and ischemic changes were seen in 17.9% (19 patients).Conclusion Screening of diabetic nephropathy in patients with type 2 diabetes mellitus helps in early treatment and avoids its more serious complications such as progression to end-stage renal disease and other extrarenal diabetic complications.

Comparison of dye-based proteinuria estimation methods with immunoturbidimetric microalbuminuria estimation, in screening for diabetic

We compared the performance of Coomassie Brilliant Blue (CBB) and Ponceau S dyes based proteinuria estimation methods with immunoturbidimetry microalbumin estimation to develop new cut-offs for proteinuria, which would help us detect diabetic nephropathy patients with better sensitivity using the above mentioned dye based methods. These proteinuria testing methods are easy to adapt in smaller laboratories typically associated with peripheral government health centers. Urine sample was collected from 158 diabetic individuals and tested simultaneously for Urine Albumin Creatinine ratio (UACR) using immunoturbidimetry and Urine Protein Creatinine Ratio (UPCR) using Ponceau S method and CBB method. The Ponceau S method gives good correlation with immunoturbidimetry, for screening of diabetic nephropathy, at UPCR cut-off of 50mg/g creatinine. The CBB method gives higher false positives. The overall agreement of Ponceau S and CBB with immunotubidimetry is maximum at cut off 50mg/g, i.e. 91% and 84% respectively. In conclusion, proteinuria estimation with Ponceau S method with UPCR >50mg/g creatinine, may be used for routine screening of diabetic patients to diagnose microalbuminuria. Keywords: Diabetic nephropathy screening, Proteinuria, Microalbuminuria, Ponceau S.

B-Type Natriuretic Peptide and High Sensitivity C-Reactive Protein Performances in the Screening for Diabetic Nephropathy in Type 2 Diabetic Patients

B-Type Natriuretic Peptide and High Sensitivity C-Reactive Protein Performances in the Screening for Diabetic Nephropathy in Type 2 Diabetic Patients

Differences in the Level of Health Care Indicators According to the Duration of Diabetes among Community-Dwelling People with Diabetes Mellitus: Analysis of the 2018 Community Health Survey in Korea

Background: This study aimed to determine whether the levels of healthcare indicators vary according to the duration of diabetes in diabetic people.Methods: From the 2018 Korean Community Health Survey, a total of 20,113 diabetic people aged 40-79 years were analyzed. The distribution of people with diabetes and its corresponding diabetes duration were as follows: 34.9%, less than 4 years; 22.4%, 5-9 years; 18.9%, 10-14 years; 9.4%, 15-19 years; and 14.1%, more than 20 years. Outcome variables included eight health behavior indicators and seven diabetes management indicators.Results: After adjusting for the sociodemographic characteristics, the longer the duration of diabetes, the less alcohol drinking and the more influenza vaccination was availed, whereas the regular tooth brushing, perceived usual stress, and perceived depressive symptoms tended to be unhealthy. Smoking, regular walking, and utilizing food nutrition label did not differ based on the duration of diabetes. Moreover, blood glucose control was evaluated to be poorly controlled as the duration of diabetes lengthened; however, diabetes management education and medical institution services (glycated hemoglobin measurement, diabetic retinopathy screening, and diabetic nephropathy screening) tended to increase significantly. There was also no difference in relation to diabetes duration in the recognition of early symptoms of myocardial infarction and stroke, which are the major complications of diabetes.Conclusions: People with long-lasting diabetes are at a higher risk of developing diabetes-related complications; therefore, more active community strategies are needed to improve their health behavior.

Diabetic Nephropathy Screening in a Residency Clinic: Improvements Also Reveal Limits of Healthcare Effectiveness Data and Information Set (HEDIS) Metric.

Quality Improvement Success Stories are published by the American Diabetes Association in collaboration with the American College of Physicians, Inc., and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article describes a resident-led initiative that improved diabetic nephropathy screening in a primary care clinic. It also highlights the challenges of complex metrics, as well as the potential unintended consequences of emphasizing one dimension of a care process over another.

Prevalence of micro albuminuria and diagnostic accuracy of urine dipstick for the screening of diabetic nephropathy in type 2 diabetes patients

Abstract Diabetic nephropathy can be early diagnosed by the detection of micro albuminuria in spot urine sample. Microalbuminuria can strongly predict the progression of renal diseases such as diabetic nephropathy among high risk population. Hypertension is a major factor which doubles the risk of renal failures. Urine dipstick method is a frequently used way for screening and evaluation of microalbuminuria so as to detect the early symptoms of diabetic nephropathy. In this background, a case control study of total 200 subjects were studied. The patient reports were diagnosed with HbA1c levels, systolic and diastolic BP, blood sugar level and other renal parameters were recorded and compared with micro albuminuria levels. Diagnostic performance of the dip stick was expressed in terms of sensitivity, specificity, PPV (positive predictive value) and NPV (negative predictive value). The statistical analysis was carried out using logistic regression analysis. The prevalence rate of microalbuminuria was higher in females when compared with males. There is no association of sex, HbA1c, diastolic bp, FBS with microalbuminuria in type 2 diabetes mellitus male subjects. The area under ROC curve for UACR (urine albumin/creatinine ratio) was 0.92 in mcroalbuminuria (p Urine dipstick method can be used for the detection of diabetic nephropathy at an early stage. It has a good diagnostic accuracy when compared with the other expensive instruments. The prevalence rate of micro albuminuria was found to be 75% for the overall population, wherein the rate was significantly higher in the case of females (41.5%) when compared to males (33.5%).

Assessment of serum cystatin C in the early detection of type 2 diabetic nephropathy in Cotonou, Benin

Introduction: Diabetic nephropathy is a frequent and dreaded complication of diabetes mellitus. The purpose of this work was to study the role of serum cystatin C in the early detection of diabetic nephropathy among type 2 diabetic patients. Methods: This was a cross-sectional study conducted in Cotonou over a period of six months. Blood samples were tested at the regional food safety testing analysis laboratory. Type 2 diabetic patients older than 15 years, who gave their informed consent, were included in the study. Patients with proven proteinuria, acute kidney injury, haematuria, a positive urine test for nitrite, or reduced glomerular filtration rate <60 mL/min/1.73 m 2 were excluded from the study. All patients were subjected to serum cystatin C and microalbuminuria assays. Results: Eighty-eight patients were included in the study. Their average age was 50.7 ± 9.6 years and the male to female ratio was 1.4:1. Twenty-four-hour microalbuminuria was positive in 53 (60%) cases whereas serum cystatin C tested positive in only 2 cases. Sensitivity and specificity tests applied to cystatin C showed very low sensitivity (4%) with a positive predictive value of 100% and high specificity (100%) with a negative predictive value of 41%. Conclusions: When compared with 24-hour microalbuminuria, serum cystatin C assay was not sensitive enough to prove suitable for screening for diabetic nephropathy. Serum cystatin C would therefore not be useful for the early detection of nephropathy among type 2 diabetic patients.

The Relation between Diabetes Type 1 and 2 Type and Microalbuminuria in Omdurman Teaching Hospital and Altyser Health Center by Using Urine Strip for Microalbuminuria in Sudanese Patients

The present work is Prospective cross sectional study. The main objective is to determine the presence of microalbuminuria in the patients urine in relation to the duration and the age and gender by using urine strip for microalbuminuria. The complications of diabetes mellitus especially end stage renal failure is a major health problem, This study is about the screening diabetic patients for microalbuminuria by simple urine strip for microalbuminuria. During period from Jan. to Aug. 2008, 100 diabetic patients were randomly selected from diabetic clinics of Omdurman Teaching Hospital and Altyser Health Center by using simple direct standardized questionnaire for 100 diabetic patients type I & II. And the urine samples were examined for microalbuminuria Results: out of 100 diabetic patients, 66% were females and 34% were males, type I constitutes about 5 % and type II about 95%, the ages range from (9-90) years. Microalbuminuria detected in about 41% of the patients and 59% had negative results, most of the patients with positive results were in age group (45 -54). The clinical practice in diabetic clinics in Sudan is not following the international guidelines regarding the screening of diabetic nephropathy, so a significant number of the diabetic patients with diabetic nephropathy are missed.

Screening for diabetic nephropathy: take your blinkers off

Proteinuria is one of several markers of kidney damage in diabetes. The excretion of specific types of protein, such as albumin or low molecular weight globulins, depends on the type of kidney disease that is present.1 One of the earliest changes in diabetes is an increase in glomerular filtration rate (GFR), or hyperfiltration, which is observed in patients with type 1 as well as many with type 2 diabetes and is accompanied by an increase in renal size.2 The next observable change is the development of albuminuria, and current UK guidance recommends annual screening with the albumin creatinine ratio (ACR) to identify early kidney disease in patients with diabetes.3 Patients with diabetes with persistent microalbuminuria are at greatly increased risk for development of proteinuria (albuminuria &gt;300 mg/day). However, it is important to exclude other causes of proteinuria in patients with diabetes, especially if there is no associated retinopathy. We report a case of an 81-year-old man with type 2 diabetes mellitus who presented with lower back pain and proteinuria but who had had normal/minimal microalbuminuria on his annual screening. He was diagnosed with multiple myeloma. The case highlights the importance of proteinuria in diagnosing multiple myeloma and the distinction between proteinuria in diabetic nephropathy and in multiple myeloma.