Evaluation of Diabetic Nephropathy: Clinical Recommendations

Diabetic nephropathy is clinically defined by the presence of persistent proteinuria of > 500 mg/day in a diabetic patient who has concomitant diabetic retinopathy and hypertension and in the absence of clinical or laboratory evidence of other kidney or renal tract disease. The presence of diabetic retinopathy is an important pre-requisite because in its absence, albuminuria in a Type 2 diabetic patient may be due to diabetic or non-diabetic glomerulosclerosis and the chances for both are equal1. Diabetic nephropathy is the leading cause of chronic renal failure worldwide. Racial differences in the prevalence of diabetic renal disease between the people of Asian ethnic origin and White Caucasians have been reported in the United Kingdom. According to Shaw, et al migrant Asian Indians had 40 times greater risk of developing end stage diabetic nephropathy (ESRD) when compared with the Caucasians2. Thus with India leading the rest of the world in claiming highest diabetic population and diabetes mellitus leading the rest of the diseases in being one of the commonest causes of end-stage renal disease and chronic renal failure, it becomes imperative for us in this country to evolve definite guidelines for evaluation of diabetic nephropathy and suggest practicable clinical recommendations to combat it. To understand the precise methods of evaluation of diabetic nephropathy at different stages, it is important to briefly dwell on the clinical course and presentation of diabetic nephropathy.