A 25-year-old man has IDDM for 5 years. His physician is concerned about the possibility of permanent renal damage. Which is the best early indicator for diabetic nephropathy?
Permanent renal damage can develop in as little as 5 years after diabetes mellitus. Diabetic nephropathy complicates about one third of cases of type 2 diabetes mellitus, and a smaller propoion of type 2 cases. One of the problems is that diabetic nephropathy tends to be asymptomatic until end-stage disease develops, so there has been considerable interest in identifying early markers for significant renal disease. The spilling of albumin into the urine and, more specifically, the spilling of very small levels of albumin ("microalbuminuria") are the best markers to date for significant diabetic nephropathy. Hypeension often coexists with, and apparently ors the development of, microalbuminuria, but is not a specific marker for renal damage. Rising blood urea nitrogen and rising creatinine occur a little later, when there is already a very significant decrease in glomerular filtration rate. Urinary tract infection can permanently damage the kidneys but does not always do so. Ref - Harrison's principles of internal medicine 20e pg 2877
Albuminuria
Hypeension
Rising blood urea nitrogen
Rising creatinine
Kidney