Early Indicator of Diabetic Nephropathy

Renal damages in diabetes appear late and progress slowly. Because of its stealthiness, it is often neglected in the early stage and when symptoms appear such as proteinuria, the renal damages have become irreversible and the best treatment period is often missed.

One reliable indicator of early renal damage is microalbuminuria. Generally, in the early diagnosis of diabetic nephropathy, early diabetic nephropathy can be confirmed if there are 2-3 times of urinary albumin being 20-200ug/min and if other factors that might cause increase of urinary albumin can be ruled out such as fever, infection, heart failure, exercises, hypertension and badly controlled blood sugar, etc.

The examination of urinary protein is the main method to measure renal damages and the most commonly adopted test is the routine urine test. Positive urinary protein indicates that there are obvious renal damages. Another examination is the 12-hour microalbuminuria quantitative. If the urinary albumin excretion rate is more than 20ug/min, it indicates early renal damages. In the early stage of diabetic nephropathy, the urinary protein can be negative, but there has already the increase of microalbuminuria. Generally diabetes has lasted for 5 years when there is microalbuminuria. There are about 80% patients with microalbumineria will develop diabetic nephropathy in the following 10 years, therefore it is very important and necessary for diabetes patients to have regular check of microalbuminuria and urinary albumin excretion rate and take proper and timely treatments once there is any abnormalities. Persistent high level of urinary albumin excretion rate (more than 20ug/min) or 24-hour urinary protein quantitative (more than 0.5g) is one of the diagnostic bases of clinical diabetic nephropathy. And when the excreted urinary albumin is more than 30-300mg/24h, it means that the renal damages have been irreversible.

In the early stage of diabetic nephropathy, the increase of microalbuminuria and glomerular filtration rate (GFR) can be reversed with proper treatments which can help slow down the progression of proteinuria and renal failure.