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Type 2 Diabetes Management Guidelines

Management of diabetic renal disease

  • Red flags for alternative causes of renal dysfunction in patients with diabetes
  • Short duration of diabetes e.g. < 5 years
  • Young patients e.g. < 30 years of age
  • Persistent decline in eGFR > 1 mL/min per month or > 10 mL/min per year (NB: eGFR is hydration dependent)
  • No evidence of diabetic retinopathy
  • Family history of renal disease
  • Overt features of alternative cause e.g. connective tissue disease, recurrent UTIs, hypertension, casts on MSU
  • Microalbuminuria is defined as more than two urinary albumin:creatinine ratios (ACR) in a greater than 3 month period of > 2.5 mg/mmol in males and > 3.5 mg/mmol in females
  • Two positive samples are required to exclude falsely raised ratios due to:
  • UTI
  • Intercurrent illness
  • Vigorous physical activity
  • Haematuria
  • Significant hyperglycaemia
  • Macroalbuminuria is defined as a urinary ACR > 30 mg/mmol
  • eGFR < 30 mL/min
  • Decline in eGFR by > 15 mL/min/year
  • Decline in eGFR by > 25% with ACEi or ARB
  • Significant proteinuria
  • Persistent red flags for alternative causes of renal dysfunction