- Screen all patients with type 2 diabetes yearly:
- Creatinine/eGFR (estimated Glomerular Filtration Rate).
- UACR (Urine Albumin to Creatinine Ratio).
- Prevent/slow CKD: BG and BP control, use of ACE Inhibitor/ARB.
- Dx CKD with ≥3 mos duration of either:
- decreased function eGFR <60 mL/min/1.73 m2 or
- evidence of damage UACR ≥30 mg/g or other.
- Initial work-up of CKD, including r/o causes not related to type 2 diabetes:
- Complete U/A, UACR
- Glucose, lytes, uric acid, Cr, BUN, Ca, Phos, CBC
- ANA, RF, C3, C4, Hep B SAg, Hep C Ab
- Dilated retinal exam, Renal U/S
- if proteinuria and patient >40 y.o.: SPEP, UPEP
- Nephrology referral if needed to sort out cause(s) of CKD
- Continuous variable
- Terms “microalbuminuria” and “macroalbuminuria” going out of use but still used for ICD9 Coding:
- Normal = <30 mg/g
- Microalbuminuria = 30-300 mg/g
- Macroalbuminura = >300 mg/g
Management of Albuminuria
The following strategies should be implemented to reduce albuminuria, prevent/slow nephropathy progression and lower the risk of CVD:
- Most important: BP control (goal <130/80).
- Maximize ACE Inhibitor (use ARB if ACE Inhibitor not tolerated).
- BG control.
- Achieve lipid goals, ASA if no contraindications, tobacco cessation.
- Protein restriction (later stages).
- Once eGFR <60 mL/min/1.73 m2, see Type 2 Diabetes and Chronic Kidney Disease Algorithm. [PDF - 229KB]
Monitoring – post CKD diagnosis
- Monitor eGFR and UACR at least once per year or more often after interventions and during later stages of CKD.