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Current statistics have shown that diabetic nephropathy is the most important single factor for developing chronic kidney failure in adults. Among all those that begin to take dialysis every year in the United States, there are about half are diabetic nephropathy. However there are some patients who will not develop diabetic nephropathy even though they have illness history of diabetes as long as 20-25 years. The reason is not very clear now and it might relate to familial or hereditary factors as well as the level of blood sugar and blood pressure.
The best and most important early indicator of diabetic nephropathy is slight increase of albumin in urine and it is called microalbuminuria (albumin in urine is 30-300mg/24h) or urinary Alb/Cr is 30-300mg/g. Without clinical interference, microalbuminuria will develop proteinuria and then gradually progress into end stage renal disease. However, proper and effective prevention and treatments can help slow down its progression into large amount of proteinuria. For type 1 diabetes patients with more than 5 years illness history, they should have regular microalbuminuria test. As for type 2 diabetes, this test is needed once diagnosed with type 2 and repeat this tests every year even though the result is normal. This is because once there is clinical proteinuria (protein in urine is more than 0.5g/24h), the glomerular functions will experience gradual and irreversible decline. There are about 75% patients will develop into end stage renal failure within 15 years.
The measuring of urinary albumin is the most sensitive and reliable indicator for detecting early diabetic nephropathy and it plays crucial role in early prevention and treatments for kidney damages.
While collecting urine sample for the microalbuminuria test, there are some points that need to be noted:
1. Avoid sampling after exercises or long term standing.
2. Avoid sampling during hematuria or urinary tract infections because they will cause the albumin in urine to increase.
