DiabeticKidneys in afya

25-50% people with diabetes get kidney disease
baseline - K, Cr eGFR, urineACR

raised ''ACR'' should be present on two out of three occasions and without
suggestion of UTI (use first pass sample)
microalbuminuria is >2.5 mg/mmol for men and >3.5 for women 
(<10 borderline nephropathy, 10-30 incipient, >30 clinical)
proteinuria is detectable on dipstick (ACR>30mg/mmol)

CKD 1 - eGFR >90 with other kidney damage (microalbuminuria)
CKD 2 - eGFR 60-89 with other kidney damage (microalbuminuria)
CKD 3-5 is eGFR <60 ± evidense of kidney damage
3a - eGFR 45-59
3b - eGFR 30-44
4 - eGFR 15-29
5 - eGFR <15
all with p if proteinuria present

''Mx''
lifestyle - weight, salt, alcohol, BP, glc control, smoking
ACE (or ARB) for all diabetics with microalbuminuria (irrespective of CKD or BP) - check K, Cr, eGFR before start and one to two weeks after every change of dose (small rise - just repeat 1/12 later <25% loss of eGFR and <30% rise in Cr is OK)
All diabetics with CKD need BP< 130/80

If tests worsen - repeat in 2/52 and check PTH, Ca and PO3 if CKD 4-5
renal US if - progressive CKD, haematuria, CKD4-5, urinary tract obstruction, FH of PCKD, need Bx or anaemia

referral guidelines ....

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