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 ....