Diabetic nephropathy urine test -
Patients with diabetic nephropathy, due to their high cardiovascular risk, should be routinely evaluated for the presence of coronary heart disease, independently of the presence of cardiac symptoms. Other atherosclerotic complications, such as carotid disease, peripheral artery disease, and atherosclerotic renal-artery stenosis should also be assessed.
This can be prevented by prior hydration and administration of an iso-osmolar contrast media Acetylcysteine, a free-radical scavenger, has also been shown to be renoprotective in some studies 90 , but this was not confirmed in a recent study In these patients, the use of ACE inhibitors or angiotensin II type 1 receptor blockers ARBs could reduce transcapillary filtration pressure, leading to acute or chronic renal insufficiency, especially if renal-artery stenosis affects both kidneys or the sole functioning kidney.
Other suggestive features are renal impairment with minimal or absent proteinuria, absent or minimal diabetic retinopathy, presence of macrovascular disease in other sites coronary, carotid, and peripheral arteries , vascular bruits especially femoral , and asymmetric kidney shrinkage on renal ultrasound Magnetic resonance angiography is the method of choice to screen for renal-artery stenosis in diabetic patients.
Other options, even though with lower sensitivity, are captopril renal scintigraphy and duplex Doppler ultrasonography imaging of the renal arteries. Rarely does renal revascularization cure hypertension, but it may improve or stabilize renal function in patients with chronic kidney disease The basis for the prevention of diabetic nephropathy is the treatment of its known risk factors: hypertension, hyperglycemia, smoking, and dyslipidemia.
These are also risk factors for cardiovascular disease and should be vigorously treated. Moreover, in the Kumamoto Study, intensive glycemic control also reduced the rate of development of micro- and macroalbuminuria Treatment of hypertension dramatically reduces the risk of cardiovascular and microvascular events in patients with diabetes.
Hypertension is common in diabetic patients, even when renal involvement is not present. The role of ACE inhibitors in the prevention of diabetic nephropathy in patients with type 1 diabetes has not been defined.
The use of perindopril during 3 years in normotensive normoalbuminuric type 1 diabetic patients delayed the increase in albuminuria In patients with type 2 diabetes, ACE inhibitors and ARBs both diminish the risk for diabetic nephropathy , and reduce the occurrence of cardiovascular events Moreover, ramipril reduced UAE at 1 year and at the end of the study Therefore, ACE inhibitors have been shown to be beneficial for reno- and cardioprotection in patients with type 2 diabetes.
The goal of treatment is to prevent the progression from micro- to macroalbuminuria, the decline of renal function in patients with macroalbuminuria, and the occurrence of cardiovascular events.
The treatment principles are the same as those adopted for the prevention of diabetic nephropathy, although in this case multiple and more intensive strategies must be used. The strategies and goals are described in Table 2. The effect of strict glycemic control on the progression from micro- to macroalbuminuria and on the rate of renal function decline in macroalbuminuric patients is still controversial.
In the DCCT study, intensified glycemic control did not decrease the rate of progression to macroalbuminuria in patients with type 1 diabetes who were microalbuminuric at the beginning of the study 95 , The Microalbuminuria Collaborative Study Group reported similar findings However, these studies , were underpowered to detect an effect of intensified glycemic control on the progression from micro- to macroalbuminuria.
Moreover, improvement of glycemic control, especially if associated with lower blood pressure levels, reduced the renal function decline in proteinuric type 1 diabetic patients In patients with type 2 diabetes, very few studies analyzed the role of blood glucose control on the progression of diabetic nephropathy.
In the Kumamoto Study, a reduction in the conversion from micro- to macroalbuminuria was observed with intensive treatment Although the effects of strict glycemic control on the progression of diabetic nephropathy are not firmly established, it should be pursued in all these patients.
Some oral antihyperglycemic agents seem to be especially useful. Rosiglitazone, as compared with glyburide, has been shown to decrease UAE in patients with type 2 diabetes.
This suggests a beneficial effect in the prevention of renal complications of type 2 diabetes Also, the use of antihyperglycemic agents in proteinuric type 2 diabetic patients should take renal function into account. Sulfonylureas and their metabolites, except glimepiride, are eliminated via renal excretion and should not be used in patients with decreased renal function Repaglinide and nateglinide have a short duration of action, are excreted independently of renal function, and have a safety profile in patients with renal impairment.
However, at this point, sulfonylureas and insulin secretagogues are usually not very effective due to the low endogenous production of insulin resulting from the long duration of diabetes.
Thus, most type 2 diabetic patients with diabetic nephropathy should be treated with insulin. In microalbuminuric type 1 and type 2 diabetic patients, numerous studies have demonstrated that treatment of hypertension, irrespective of the agent used, produced a beneficial effect on albuminuria Renin-angiotensin system RAS blockade with ACE inhibitors or ARBs confers an additional benefit on renal function.
This renoprotective effect is independent of blood pressure reduction , and may be related to decreased intraglomerular pressure and passage of proteins into the proximal tubule These drugs decrease UAE and the rate of progression from microalbuminuria to more advanced stages of diabetic nephropathy.
ARBs were also effective in reducing the development of macroalbuminuria in microalbuminuric type 2 diabetic patients. It is also interesting to note that UAE was still reduced 1 month after the withdrawal of irbesartan These data reinforce the idea that the antiproteinuric effect of ARBs is blood pressure independent.
Although there is no long-term study comparing the effects of ACE inhibitors and ARBs on the progression from microalbuminuria to overt diabetic nephropathy, both agents led to a similar reduction in albuminuria in a week study and a 1-year study Therefore, the use of either ACE inhibitors or ARBs is recommended as a first-line therapy for type 1 and type 2 diabetic patients with microalbuminuria, even if they are normotensive In proteinuric patients, Mogensen was the first to demonstrate, almost 30 years ago, that treatment of hypertension reduced albuminuria and the rate of GFR decline in type 1 diabetic patients.
Subsequently, other studies have clearly demonstrated that aggressive treatment of hypertension has a strong beneficial effect in reducing GFR decline in proteinuric type 1 diabetic patients This reduction in GFR decline was predicted by reduction in albuminuria According to the MDRD Modification of Diet in Renal Disease trial, the lower the blood pressure, the greater the preservation of renal function in nondiabetic patients Although this study included mainly nondiabetic patients, this goal also has been recommended for proteinuric diabetic patients Addition of ACE inhibitors in proteinuric type 1 diabetic patients or ARBs in macroalbuminuric type 2 diabetic patients , decreased proteinuria and renal function decline.
Although there was no difference in the cardiovascular event rate, a significantly lower incidence of congestive heart failure was observed among patients receiving ARBs The antiproteinuric effect of ARBs has certain characteristics.
It occurs early within 7 days after treatment is started and persists stable thereafter , and it is independent of blood pressure reduction and has a dose-response effect beyond the doses needed to control blood pressure This raise in creatinine is associated with long-term preservation of renal function, and therefore ACE inhibitors should not be stopped Greater increases should raise the suspicion of renal-artery stenosis.
Inhibition of the RAS, especially with ACE inhibitors, might raise serum potassium levels, particularly in patients with renal insufficiency For these reasons, albuminuria, serum creatinine, and potassium should be checked monthly during the first 2—3 months after starting treatment with ACE inhibitors or ARBs.
Recently, Mogensen et al. ACE inhibitors and ARBs interrupt the RAS at different levels, and the combination of these classes of drugs may have an additive effect on renoprotection. Other studies have also demonstrated that the combination of ACE inhibitors and ARBs had a synergistic effect in blood pressure and UAE reduction in patients with type 1 and type 2 diabetes with diabetic nephropathy.
RAS dual blockade is more effective in reducing UAE than maximal recommended doses of ACE inhibitors alone Even though no long-term trials analyzing the benefit of RAS dual blockade in diabetic nephropathy are available, in nondiabetic proteinuric patients the COOPERATE Combination Treatment of Angiotensin-II Receptor Blocker and Angiotensin-Converting-Enzyme Inhibitor in Nondiabetic Renal Disease trial has shown that dual therapy was superior to monotherapy at its maximal doses in retarding the progression of renal disease in a 3-year follow-up The combination of spironolactone, an aldosterone antagonist, with an ACE inhibitor was also more effective in reducing UAE and blood pressure in micro- and macroalbuminuric type 2 diabetic patients than the ACE inhibitor alone A detailed discussion of the agents used to treat hypertension in patients with diabetic nephropathy is beyond the scope of this article, and recent guidelines , and reviews on this subject are available , , Therefore, only general guidelines will be discussed here, taking into account the special characteristics of these patients.
It is more important to reach the blood pressure goals than to use a particular agent, since most patients will require several agents. However, due to the known renoprotective effect of ACE inhibitors and ARBs, treatment should start with either of these agents. Patients with systolic blood pressure 20 mmHg or diastolic blood pressure 10 mmHg above the goal should start treatment with two agents.
An ACE inhibitor or ARB and a low-dose thiazide diuretic ARBs and ACE inhibitors can be combined if there is no reduction in albuminuria or if blood pressure target levels are not reached, even before maximizing the dose of each agent.
Additional agents should be added as needed. Calcium channel blockers have an additional effect on reducing blood pressure levels. These agents should only be used in combination with an ACE inhibitor and should not be used in patients with a recent coronary event.
Possibly, a metabolic neutral compound, carvedilol, should be used. The combination of β-blockers and nondihydropyridine calcium channel blockers should be used with caution, since both agents have negative chronotropic effects.
Blood pressure treatment could be assessed by h ambulatory monitoring in the following situations: in patients with treatment-resistant hypertension, when there is a suspicion of white coat hypertension, or to detect drug-induced or autonomic neuropathy—related hypotensive episodes This was probably related to the lower amount of saturated fat and the higher proportion of polyunsaturated fatty acids found in chicken meat than in red meat.
The beneficial effect of polyunsaturated fatty acids on endothelial function could also reduce UAE. A normal protein diet with chicken as the only source of meat may represent an additive strategy for the treatment of microalbuminuric type 2 diabetic patients. However, long-term studies are necessary.
According to a meta-analysis of five studies including a total of patients, dietary protein restriction slowed the progression of diabetic nephropathy in patients with type 1 diabetes. More recently, a 4-year randomized controlled trial in 82 patients with type 1 diabetes with progressive diabetic nephropathy showed that a moderately low—protein diet 0.
The effect of lipid reduction by antilipemic agents on progression of diabetic nephropathy is still unknown. So far, there have been no large trials analyzing whether the treatment of dyslipidemia could prevent the development of diabetic nephropathy or the decline of renal function.
However, there is some evidence that lipid reduction by antilipemic agents might preserve GFR and decrease proteinuria in diabetic patients Moreover, the results of the recently presented CARDS Collaborative Atorvastatin Diabetes Study , which showed a marked reduction of cardiovascular events in patients with diabetes and at least one additional risk factor for coronary artery disease, suggest that all diabetic patients should be taking statins www.
Furthermore, anemia has been considered a risk factor for progression of renal disease and retinopathy Low-dose aspirin has been recommended for primary and secondary prevention of cardiovascular events in adults with diabetes.
This therapy did not have a negative impact on renal function UAE or GFR in type 1 and type 2 diabetic patients with micro- or macroalbuminuria , Although this study was underpowered to analyze the effect on the development of cardiovascular events, these data raise the issue that diabetic patients could be less responsive to aspirin therapy aspirin resistance.
This phenomenon was associated with higher levels of A1c, lower concentration of HDL cholesterol, and higher concentration of total cholesterol Patients with microalbuminuria frequently have other cardiovascular risk factors, such as hypertension and dyslipidemia.
In the Steno-2 study, multifactorial intervention was compared with conventional treatment in microalbuminuric type 2 diabetic patients The multifactorial intervention consisted of a stepwise implementation of lifestyle changes and pharmacological therapy, including a low-fat diet, a three to five times a week light-to-moderate exercise program, a smoking cessation program, and prescription of ACE inhibitors or ARBs and aspirin.
The measures described above might not be effective in some patients with diabetes, and novel therapeutic strategies are warranted. High doses of thiamine and its derivate benfotiamine have been shown to retard the development of microalbuminuria in experimental diabetic nephropathy, probably due to decreased activation of protein kinase C, decreased protein glycation, and oxidative stress Treatment with ALT, a cross-link breaker of the advanced glycation end products, has been shown to result in a significant reduction in UAE, blood pressure, and renal lesions in experimental diabetes Treatment with a protein kinase C β inhibitor ruboxistaurin normalized GFR, decreased albumin excretion rate, and ameliorated glomerular lesions in diabetic rodents Regular screenings are the most effective way to monitor changes in kidney health.
They can make early detection possible so treatment and lifestyle changes can slow or stop the progression of diabetic nephropathy.
Regularly screening your kidney health is a part of actively managing diabetes. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available.
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One of the most common electrolyte imbalances experienced by people with kidney disease, which can lead to muscle weakness, pain, or even paralysis…. A low GFR may be an indicator of kidney…. High protein levels in the urine are known as proteinuria. Discover 11…. A urine protein test measures the amount of protein in urine.
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Health Conditions Discover Plan Connect. How to Screen for Diabetes-Related Nephropathy. Medically reviewed by Kelly Wood, MD — By Corinna Cornejo on February 13, Urine protein test. Estimated glomerular filtration rate eGFR.
Imaging tests. Kidney biopsy. Learn more about diabetic nephropathy You can lower your risk of diabetes-related kidney disease by regularly monitoring and managing your glucose levels and kidney health, along with getting annual health screens.
Was this helpful? How often should you get screened for diabetic kidney disease? Is there a test that diagnoses diabetes kidney disease? Can I get home tests for all of the above, or only for ketones? How reliable are home testing kits? Yes, you can test for several things, including glucose, ketones, bilirubin, and more at home.
To ensure reliability, check that the test strips have not expired and follow the directions carefully. In most cases, it is necessary to compare the color of the strip against a color chart. You will need to do this a specific amount of time after dipping the strip in the urine.
Deborah Weatherspoon, PhD, RN, CRNA Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.
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Medical News Today. Health Conditions Health Products Discover Tools Connect. Urine test for diabetes: What you need to know. Medically reviewed by Deborah Weatherspoon, Ph. Types of tests What to expect Home testing Results Follow-up A person with diabetes may need to have a urine test if they notice blood in their urine, or to check for high blood sugar, diabetic ketoacidosis, or a urinary tract infection.
Types of test. Share on Pinterest A urine test is an noninvasive way of testing for glucose, ketones, and other substances. What to expect. Share on Pinterest If the testing strip changes color, ketones, glucose, or other substance may be present.
Home testing. Share on Pinterest The doctor may suggest adjusting treatment, depending on the results. Q: I would like to to do my testing at home before going to the doctor for confirmation.
A: Yes, you can test for several things, including glucose, ketones, bilirubin, and more at home. Be prepared with good lighting and a timer to help you accurately read the results.
Was this helpful? How we reviewed this article: Sources. Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. We avoid using tertiary references. We link primary sources — including studies, scientific references, and statistics — within each article and also list them in the resources section at the bottom of our articles.
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A person with diabetes may need to Caloric intake for muscle gain a Hrine test if they notice blood in their Diaetic, or to check for high Diabetic nephropathy urine test sugar, diabetic ketoacidosis, nephropsthy a urinary tract infection. A urine test Dibetic non-invasive, and people often use them at home. However, healthcare professionals may use a urine test if they cannot access a vein for a blood test, or if a person has anxiety or a fear of needles. The results may be less accurate than those of a blood test, but urine tests can still play an important role. In this article, we look at types of urine tests for diabetes and how to understand the results. A urine test can detect various substances, including glucose, ketones, protein, bacteria, and bilirubin.
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