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• #1 Diagnosis of diabetic kidney disease: state of the art and future perspective

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6336222/

  Approximately 20% to 40% of patients with type 1 or type 2 diabetes mellitus develop diabetic kidney disease. This is a clinical syndrome characterized by persistent albuminuria ( 300 mg/24 h, or 300 mg/g creatinine), a relentless decline in glomerular filtration rate (GFR), raised arterial blood pressure, and enhanced cardiovascular morbidity and mortality. Regular, systematic screening for diabetic kidney disease is needed in order to identify patients at risk of or with presymptomatic diabetic kidney disease. Annual monitoring of urinary albumin-to-creatinine ratio, estimated GFR, and blood pressure is recommended. Diabetic kidney disease is a major cause of morbidity and mortality in diabetes. Clinically, diabetic kidney disease is characterized by progressive kidney damage reflected by increasing albuminuria, impairment in renal function (decline in glomerular filtration rate [GFR]), elevated blood pressure, and excess morbidity and mortality due to cardiovascular complications. Diabetic kidney disease is the single most common cause of ESRD in many parts of the world including Europe, Japan, and the USA, and patients with diabetes account for 25% to 45% of all patients enrolled in ESRD programs.

• #1 Diabetic kidney disease – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/530

  Diabetic kidney disease (DKD) is usually a clinical diagnosis in a patient with long-standing diabetes (10 years) with albuminuria and/or reduced estimated glomerular filtration rate (eGFR) in the absence of signs or symptoms of other primary causes of kidney damage. […] The diagnosis of DKD is most conclusively made by findings of mesangial expansion and nodular glomerulosclerosis on kidney biopsy, though kidney biopsy is rarely necessary. […] 1st investigations to order include urinalysis, urinary albumin to creatinine ratio (ACR), serum creatinine with GFR estimation, and kidney ultrasound. […] Investigations to consider include cystatin C with GFR estimation, albumin excretion rate (AER), CT abdomen, magnetic resonance angiography (MRA), Doppler ultrasound, and kidney biopsy.

• #1 Diabetic Nephropathy – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK534200/

  Diabetic nephropathy is the leading cause of end-stage renal disease in developed countries, including the United States. As a microvascular complication, it affects individuals with both type 1 and type 2 diabetes. […] Traditional markers of DKD, such as albuminuria and creatinine, are relatively insensitive and have limited utility due to delayed detection. […] Diagnosis involves albuminuria assessment, with thresholds for moderate and severe stages. […] Diabetic nephropathy is diagnosed by persistent albuminuria on 2 or more occasions, separated by at least 3 months, using early morning urine samples. Persistent albuminuria is defined as 300 mg/d or greater. […] Moderately increased albuminuria, a marker of early diabetic nephropathy, is between 30 and 300 mg over 24 hours. […] Severe albuminuria is classified as greater than 300 mg of albuminuria per day.

• #1 Current Challenges in Diabetic Nephropathy: Early Diagnosis and Ways to Improve Outcomes

  https://e-enm.org/journal/view.php?number=1752

  Measuring the quantity of albumin in a 24-hour urine collection has been considered the gold standard for the diagnosis of diabetic nephropathy. […] Recently, guidelines recommend the use of the albumin-to-creatinine ratio (ACR) of a spot urine sample, a technique that can be performed easily in the clinic setting as a surrogate for the amount of urinary albumin in a 24-hour urine collection. […] The American Diabetes Association (ADA) recommends that a patient is considered to have albuminuria when at least two of three measurements of urine ACR examined within 6 months are abnormal. […] The rate of progression from category A2 to category A3 is predicted to be 2% to 3% per year, and this progression is associated with a decrease in glomerular filtration rate (GFR). […] Persistently and moderately increased urinary ACR (A2) is an index of development of diabetic kidney disease and is also a well-established indicator of increased CVD risk.

• #1 Diabetic Nephropathy Workup: Approach Considerations, Urinalysis, Blood Tests

  https://emedicine.medscape.com/article/238946-workup

  Diabetic nephropathy is characterized by the following: Persistent albuminuria (300 mg/d or 200 g/min) that is confirmed on at least 2 occasions 3-6 months apart […] A relentless decline in the glomerular filtration rate (GFR) […] Elevated arterial blood pressure. […] Whether cystatin C or creatinine-based calculation of GFR is the most sensitive measure for assessing early decline in renal function in patients with type 2 diabetes who have mild-to-moderate chronic kidney disease is controversial. […] A 24-hour urinalysis for urea, creatinine, and protein is extremely useful in quantifying protein losses and estimating the GFR. Typically, the urinalysis results from a patient with established diabetic nephropathy show proteinuria varying from 150 mg/dL to greater than 300 mg/dL, glucosuria, and occasional hyaline casts.

• #1 Diagnosis, Treatment Goals, and Management of Diabetic Kidney Disease in the Elderly | Consultant360

  https://www.consultant360.com/articles/diagnosis-treatment-goals-and-management-diabetic-kidney-disease-elderly

  A positive spot UACR should be confirmed within 3 to 6 months in the absence of factors that may contribute to false-positive results, including exercise within 24 hours of the test, concurrent urinary tract infection, fever, heart failure, hyperglycemia, hypertension, and high protein dietary intake over the several days prior to testing. […] Albuminuria will usually be present for several years prior to a decline in eGFR; therefore, attempts to slow DKD progression should be initiated once microalbuminuria is confirmed. […] In patients with DKD, progression to ESRD closely correlates with the degree of proteinuria, affecting less than 10% of patients with less than 1 gram of proteinuria per day as compared with nearly 3 times that in patients with 2 to 4 grams of proteinuria per day.

• #1 Diagnosis of diabetic kidney disease: state of the art and future perspective

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6336222/

  Annual screening of all individuals with diabetes is recommended to detect abnormal and/or changing levels of albuminuria and renal function (i.e., eGFR), so that early renoprotective treatment may be initiated. The second clinical variable to assess in screening for diabetic kidney disease is eGFR, using creatinine-based formulae such as the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. The classification of diabetic kidney disease based on albuminuria and eGFR level is simple, provides prognostic information, and is helpful to guide therapeutic decisions; but it is not perfect. Therefore an intensive search for new biomarkers in blood or urine that could improve diagnostic and prognostic precision in early or later stages of diabetic kidney disease has been ongoing during the past decades.

• #1 Diabetic nephropathy (kidney disease)

  https://johnsonmemorial.org/jmh-health-information-library-disease/con-20203560

  Diabetic nephropathy usually is diagnosed during the regular testing that’s part of managing diabetes. Get tested every year if you have type 2 diabetes or have had type 1 diabetes for more than five years. […] Routine screening tests may include: […] Urinary albumin test. This test can detect a blood protein called albumin in urine. Typically, the kidneys don’t filter albumin out of the blood. Too much albumin in your urine can mean that the kidneys aren’t working well. […] Albumin/creatinine ratio. Creatinine is a chemical waste product that healthy kidneys filter out of the blood. The albumin/creatinine ratio measures how much albumin compared to creatinine is in a urine sample. It shows how well the kidneys are working. […] Glomerular filtration rate (GFR). The measure of creatinine in a blood sample may be used to see how quickly the kidneys filter blood. This is called the glomerular filtration rate. A low rate means the kidneys aren’t working well.

• #1 Diabetic Nephropathy Explained: Symptoms, Diagnosis, Treatment & Self-Care – The Kingsley Clinic

  https://thekingsleyclinic.com/pancreas/diabetic-nephropathy-explained-symptoms-diagnosis-treatment-self-care/

  The Blood Urea Nitrogen (BUN) test measures the amount of urea nitrogen, a waste product, in your blood. Increased BUN levels may suggest that your kidneys aren’t functioning properly, potentially due to DN. […] The Serum Creatinine Test measures the level of creatinine, another waste product, in your blood. An increased level often indicates impaired kidney function and is a crucial marker for DN. […] The Glomerular Filtration Rate (GFR) is a calculation that determines how well your kidneys are filtering your blood. It’s the best overall measure of kidney function and can help your healthcare provider identify the stage of kidney disease. […] A kidney ultrasound is an imaging test that allows healthcare providers to examine the size, shape, and location of your kidneys. It can help identify abnormalities such as kidney size reduction or structural problems, which can be signs of DN.

• #1 Diabetes Canada | Clinical Practice Guidelines

  https://guidelines.diabetes.ca/cpg/chapter29

  Identification of chronic kidney disease in people with diabetes requires screening for proteinuria, as well as an assessment of serum creatinine converted into an estimated glomerular function rate (eGFR). […] The development and progression of renal damage in diabetes can be reduced and slowed through intensive glycemic control and optimization of blood pressure. Progression of chronic kidney disease in diabetes can also be slowed through the use of medications that disrupt the renin angiotensin aldosterone system. […] The earliest stage of diabetic nephropathy is hyperfiltration, where the glomerular filtration rate (GFR) is significantly higher than normal. Identification of hyperfiltration is not clinically useful, as it is difficult to determine from routine testing and is not present in all people with early diabetic nephropathy. Persistent albuminuria is considered the earliest clinical sign of diabetic nephropathy.

• #1 Diabetic nephropathy (kidney disease)

  https://johnsonmemorial.org/jmh-health-information-library-disease/con-20203560

  Other diagnostic tests may include: […] Imaging tests. X-rays and ultrasound can show the makeup and size of the kidneys. CT and MRI scans can show how well blood is moving within the kidneys. You may need other imaging tests, as well. […] Kidney biopsy. This is a procedure to take a sample of kidney tissue to be studied in a lab. It involves a numbing medicine called a local anesthetic. A thin needle is used to remove small pieces of kidney tissue.

• #1 Diabetic Nephropathy Workup: Approach Considerations, Urinalysis, Blood Tests

  https://emedicine.medscape.com/article/238946-workup

  Microalbuminuria is defined as albumin excretion of more than 20 g/min or an albumin-to-creatinine ratio (g/g) of greater than 30. This phase indicates incipient diabetic nephropathy and calls for aggressive management, at which stage the disease may be potentially reversible (ie, microalbuminuria can regress). […] Blood tests, including calculation of GFR (by various formulas, such as the MDRD formula), are helpful in monitoring for the progression of kidney disease and in assessing its stage. […] Renal biopsy is not routinely indicated in all cases of diabetic nephropathy, especially in persons with a typical history and a progression typical of the disease. It is indicated if the diagnosis is in doubt, if other kidney disease is suggested, or if atypical features are present. […] The following three major histologic changes occur in the glomeruli of persons with diabetic nephropathy: First, mesangial expansion is directly induced by hyperglycemia, perhaps via increased matrix production or glycosylation of matrix proteins. Second, thickening of the glomerular basement membrane (GBM) occurs. Third, glomerular sclerosis is caused by intraglomerular hypertension (induced by renal vasodilatation or from ischemic injury induced by hyaline narrowing of the vessels supplying the glomeruli).

• #1 Diabetic Nephropathy: Symptoms, Causes, Diagnosis and treatment PACE Hospitals – Best Hospitals in Hitech City, Hyderabad, India | Near Madhapur, Kukatpally, KPHB, Kondapur, Gachibowli, Jubilee Hills, Banjara HillsPACE Hospitals Contact N

  https://www.pacehospital.com/diabetic-nephropathy

  To determine whether you have diabetic kidney disease, these tests and procedures can help, such as: Blood tests. If you have diabetes, you will need blood tests to check levels of BUN and creatinine and monitor your condition that will determine how well your kidneys are working. […] Urine samples provide information whether you have too much protein in the urine. High levels of a protein (microalbumin) may indicate your kidneys are being affected. […] Imaging tests. X-rays and ultrasound are advised to assess your kidneys’ size and structure. […] After other diagnostics, nephrologist may recommend a kidney biopsy to remove a sample of kidney tissue. […] In the early stages of diabetic nephropathy, treatment plan may include various medications to control the causes of it: Manage and Control high blood sugar.

• #1 Diabetic Nephropathy Workup: Approach Considerations, Urinalysis, Blood Tests

  https://emedicine.medscape.com/article/238946-workup

  The Renal Pathology Society proposed a histologic classification system for diabetic nephropathy in 2010, which can be used for both type 1 and type 2 DM. Based on the presence and severity of glomerular lesions, four classes are proposed: Class I, glomerular basement membrane thickening; Class II, mesangial expansion; Class III, nodular sclerosis (Kimmelstiel-Wilson lesions); Class IV, advanced diabetic glomerulosclerosis. […] In this report, a separate classification was proposed based on the presence and severity of interstitial fibrosis and tubular atrophy (IFTA) and vascular lesions. Generally, the classification is believed to correspond to the clinical stages of diabetic nephropathy, although there are no definitive data validating this correspondence.

• #1 A Differential Diagnosis Model For Diabetic Nephropathy And Non-Diabet | DMSO

  https://www.dovepress.com/a-differential-diagnosis-model-for-diabetic-nephropathy-and-non-diabet-peer-reviewed-fulltext-article-DMSO

  The pathological diagnosis of DN was based on the pathological criteria for DN, as published by the Renal Pathology Society in 2010: mild or nonspecific changes observed through light microscopy along with electron microscopy-proven glomerular basement membrane thickening, mesangial expansion, nodular sclerosis, or advanced diabetic glomerulosclerosis. […] Our differential diagnostic model was based on the following logistic regression model: logit(P)=+++ +, after transformation; that is, P=, where P represents probability, e represents a mathematical constant (e=2.71828 ), xm represents the predictors, 0 is a constant, m is an estimator, and P is the probability of NDRD diagnosis (PNDRD). […] We found that the baseline eGFR in the NDRD group was higher than that recorded in the DN group (39.8 [26.7, 67.1)] vs 76.8 [38.3, 97.9], respectively; P0.001). […] In the present study, we developed a diagnostic model based on logistic regression featuring six variables, which can effectively discriminate between DN and NDRD.

• #1 Diabetic Nephropathy – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK534200/

  Neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) are elevated in early diabetic nephropathy, even before the onset of albuminuria, and correlate with a decline in decreased GFR. […] The most studied biomarkers for diabetic nephropathy include NGAL, KIM-1, and periostin. […] The management of diabetic nephropathy focuses on 4 key areas, including cardiovascular risk reduction, glycemic control, blood pressure (BP) control, and inhibition of the renin-angiotensin system (RAS). […] The KDIGO guidelines recommend a BP target of less than 120/80 mm Hg for individuals with diabetes, allowing for individualization based on patient-specific factors. […] The use of ACEIs or ARBs in cases of albuminuria without hypertension remains insufficiently studied and should be considered on an individual basis. […] Diabetic nephropathy is associated with high morbidity and mortality. Microalbuminuria is an independent risk factor for cardiovascular mortality, and the majority of patients ultimately die from ESRD.

• #1 Diabetic Nephropathy – a Review of Risk Factors, Progression, Mechanism, and Dietary Management

  https://www.biomolther.org/journal/view.html?uid=1312&vmd=Full&

  An early symptom of DN includes high excretion of albumin in urine, glomerular and renal hypertrophy, hyperfiltration, and mesangial expansion with ECM proteins aggregation such as fibronectin, laminin, and collagen. […] For both T1DM and T2DM, serum TNF- receptor level is the most effective diagnostic tool and forecasts the development of CKD and ESRD. In type II diabetics, besides albuminuria, the levels of TNF- receptor exhibited as a significant predictive factor. Furthermore, serum uric acid acts as a biomarker and pathogenic. […] Beta-trace protein (beta TP), microRNA-130b, and NGAL are recently explored as valuable biomarkers for diagnosis in T2DM patients. […] The key treatment choices for DN are maintenance of blood glucose levels, hypertension, hemodynamic control, and other metabolic disorders.

• #1 【CKD】To diagnose diabetic nephropathy in early stage | L-FABP -Early Diagnosis of Kidney Diseases-

  https://fabp.jp/eng/about/effect/dept-ckd.php

  140 diabetic nephropathy patients were divided into 4 groups based on the degree of albuminuria or renal function. […] Urinary L-FABP level of diabetic nephropathy patients is significantly high comparing to healthy person and increases according to the degree of disease progression. These results show that urinary L-FABP is useful for early diagnosis of diabetic nephropathy. […] To diagnose diabetic nephropathy in early stage. […] To identify the risk of diabetic nephropathy progress in early stage.

• #1 Diagnosis of diabetic kidney disease: state of the art and future perspective

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6336222/

  Screening, diagnosis, and treatment for diabetic kidney disease have advanced substantially over the last 3 decades, improving both time to diagnosis and life-years gained after diagnosis. Diabetic kidney disease (also termed chronic kidney disease [CKD] due to diabetes or diabetic nephropathy) is defined in both type 1 and type 2 diabetes as the presence of persisting severely elevated albuminuria of 300 mg/24 h (or 200 g/min), or an albumin-to-creatinine ratio (ACR) of 300 mg/g, confirmed in at least 2 of 3 samples, with concurrent presence of diabetic retinopathy and absence of signs of other forms of renal disease. The presence of moderately elevated urine albumin excretion (microalbuminuria) (30300 mg/g) is widely regarded as a precursor of diabetic nephropathy, both indicating early risk and providing a target for intervention.

• #1 Diabetic Nephropathy – Genitourinary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/genitourinary-disorders/glomerular-disorders/diabetic-nephropathy

  Diabetic nephropathy is glomerular sclerosis and fibrosis caused by the metabolic and hemodynamic changes of diabetes mellitus. Diagnosis is based on history, physical examination, urinalysis, and urine albumin/creatinine ratio. […] The diagnosis is suspected in patients with diabetes who have proteinuria, particularly if they have diabetic retinopathy (indicating small vessel disease) or risk factors for diabetic nephropathy. […] Yearly screening of all patients with diabetes with random urine albumin/creatinine ratio. […] Patients are tested for proteinuria by routine urinalysis; if proteinuria is present, testing for microalbuminuria is unnecessary because the patient already has macroalbuminuria suggestive of diabetic kidney disease. […] For most patients with diabetes who have proteinuria, the diagnosis is clinical. Renal biopsy can confirm the diagnosis but is rarely necessary.

• #1 Diabetic Nephropathy: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/238946-overview

  Diabetic nephropathy is a clinical syndrome characterized by the following: Persistent albuminuria (300 mg/d or 200 g/min) that is confirmed on at least 2 occasions 3-6 months apart. Progressive decline in the glomerular filtration rate (GFR). Elevated arterial blood pressure. […] Currently, diabetic nephropathy is the leading cause of chronic kidney disease in the United States and other Western societies. It is also one of the most significant long-term complications in terms of morbidity and mortality for individual patients with diabetes. Diabetes is responsible for 30-40% of all end-stage renal disease (ESRD) cases in the United States. […] Good evidence suggests that early treatment delays or prevents the onset of diabetic nephropathy or diabetic kidney disease. This has consistently been shown in both type 1 and type 2 diabetes mellitus.

• #1 Diabetic nephropathy: Diagnosis, screening and management – DiabetesontheNet

  https://diabetesonthenet.com/diabetes-primary-care/diabetic-nephropathy-diagnosis-screening-and-management-1/

  Diabetic nephropathy remains the most common cause of end-stage renal failure and is associated with increased cardiovascular morbidity and mortality. […] Early identification and evidence-based intervention are critical to prevent development and to slow progression. […] Albuminuria is thus the earliest clinical feature of nephropathy. […] The detection of albuminuria is the cornerstone of diagnosis of nephropathy. […] At diagnosis, GFR can be elevated in people with type 1 or 2 diabetes. […] The rate of decline thereafter determines the progression of nephropathy and likely timing of end-stage renal disease (ESRD) requiring renal replacement therapy. […] This estimated GFR has been used as a basis for diagnosis and staging of chronic kidney disease (CKD). […] The presence of retinopathy in a person with diabetes and albuminuria makes a diagnosis of diabetic nephropathy almost certain. […] Nephropathy is a serious complication of diabetes and is associated with significant mortality and comorbidity. However, there is a strong evidence base for therapies that can prevent development and slow its progression.

• #1 Diabetic kidney disease – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/530

  Diabetic kidney disease (DKD) is usually a clinical diagnosis in a patient with long-standing diabetes (10 years) with albuminuria and/or reduced estimated glomerular filtration rate (eGFR) in the absence of signs or symptoms of other primary causes of kidney damage. […] The diagnosis of DKD is most conclusively made by findings of mesangial expansion and nodular glomerulosclerosis on kidney biopsy, though kidney biopsy is rarely necessary. […] Key diagnostic factors include hypertension, signs of retinopathy, and edema. […] 1st tests to order include urinalysis, urinary albumin to creatinine ratio (ACR), serum creatinine with GFR estimation, and kidney ultrasound. […] Other cause(s) of CKD should be considered in the presence of rapidly increasing albuminuria or nephrotic syndrome, rapidly decreasing eGFR, active urinary sediment, the absence of diabetic retinopathy in patients with type 1 diabetes, or signs or symptoms of other systemic disease.

• #1 The Diagnostic Performance of a Clinical Diagnosis of Diabetic Kidney Disease

  https://www.mdpi.com/2075-1729/13/7/1492

  The Diagnostic Performance of a Clinical Diagnosis of Diabetic Kidney Disease […] Background: Diabetic kidney disease (DKD), a common cause of CKD and kidney failure, is usually diagnosed clinically. However, there is little evidence comparing the performance of a clinical diagnosis to biopsy-proven diagnosis. Purpose of the study: Diagnostic performance of a clinical diagnosis was determined in a group of patients with diabetes and chronic kidney disease who underwent kidney biopsy after an initial clinical diagnosis. […] A total of 37 of 43 patients clinically diagnosed with DKD also had biopsy-proven DKD, whilst only 1 of 11 patients who had clinically diagnosed NDKD had biopsy-proven DKD. Sensitivity was 97.4%, specificity was 62.5%, positive predictive value 86%, and negative predictive value 90.9%. […] The diagnosis of DKD is usually made based on clinical rather than histopathological findings. […] The clinical diagnosis of DKD is not as straightforward as it might first appear. DKD can co-exist with other primary kidney diseases. […] Given the reliance on a “clinical diagnosis” of DKD, there is little published evidence on its diagnostic performance (sensitivity, specificity, positive predictive value, negative predictive value, and accuracy) compared to the “gold standard” histopathological diagnosis. […] Our results show that in this care setting, the sensitivity of clinical diagnosis for the presence of DKD was very high (i.e., unlikely to miss the diagnosis of the condition) and it did not seem to matter whether the clinical diagnosis of DKD was first or second listed (i.e., no obvious effect of diagnostic hierarchy). The specificity was lower, suggesting a tendency to “over-diagnose” the condition. However, given the higher prevalence of DKD compared to NDKD in this population, the negative predictive value was also high, i.e., “no likely means no”. The overall accuracy of clinical diagnosis was >80%. […] We have shown that clinician-labelled diagnosis of DKD in the kidney specialist care setting has high sensitivity and seems unlikely to miss diagnosing cases. However, there is a tendency towards overdiagnosis (lower specificity).

• #1 Diagnosis, Treatment Goals, and Management of Diabetic Kidney Disease in the Elderly | Consultant360

  https://www.consultant360.com/articles/diagnosis-treatment-goals-and-management-diabetic-kidney-disease-elderly

  The diagnosis and staging of CKD is based upon estimated glomerular filtration rate (eGFR) measurements (the main determinant of overall kidney function) and the presence of kidney damage, most often defined as an increased rate of urinary albumin excretion. According to the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (KDOQI), stage 1 CKD is defined as persistent albuminuria with a normal GFR (90 mL/min/1.73 m2); stage 2 CKD as persistent albuminuria with a GFR of 60 to 89 mL/min/1.73 m2; stage 3 CKD as a GFR of 30 to 59 mL/min/1.73 m2; stage 4 CKD as a GFR of 15 to 29 mL/min/1.73 m2; and stage 5 CKD (kidney failure) as a GFR of less than 15 mL/min/1.73 m2. […] Current guidelines recommend screening patients with diabetes for DKD using measurements of kidney damage (albuminuria) and function (eGFR) beginning 5 years after the diagnosis of type 1 DM or at the time of diagnosis of type 2 DM, and then annually thereafter. Microalbuminuria, a marker of early diabetic nephropathy, will not be detected through routine urine dipstick measurements and therefore should be evaluated using a spot UACR.

• #1 Diabetic Kidney Disease: Diagnosis, Treatment, and Prevention | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0615/p751.html

  Globally, approximately 20% of the 400 million individuals with diabetes mellitus have diabetic kidney disease (DKD). DKD is associated with higher cardiovascular and all-cause morbidity and mortality, so timely diagnosis and treatment are critical. Screening for early DKD is best done with annual spot urine albumin/creatinine ratio testing, and diagnosis is confirmed by repeated elevation in urinary albumin excretion. […] Diagnosis is made clinically when a patient has evidence of kidney disease and no other primary etiology. Early referral to nephrology (at chronic kidney disease stage 3 or 4) may help improve DKD outcomes and should be considered.

• #1 Chronic Kidney Disease: Detection and Evaluation | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/1215/p776.html

  Chronic kidney disease affects 47 million people in the United States and is associated with significant health care costs, morbidity, and mortality. […] Multiple guidelines recommend at least annual screening with serum creatinine, urine albumin/creatinine ratio, and urinalysis for patients with risk factors, particularly diabetes mellitus, hypertension, and a history of cardiovascular disease. […] Persistently elevated serum creatinine and albuminuria are diagnostic and prognostic hallmarks of chronic kidney disease. […] New guidelines incorporate albuminuria into the classification framework for chronic kidney disease and elaborate on identification of the disease, the frequency of follow-up, and recommendations for nephrology referral. […] Nephrology consultation is indicated for patients with an estimated glomerular filtration rate less than 30 mL per minute per 1.73 m2, persistent urine albumin/creatinine ratio greater than 300 mg per g or urine protein/creatinine ratio greater than 500 mg per g, or if there is evidence of a rapid loss of kidney function.

• #1 Current Challenges in Diabetic Nephropathy: Early Diagnosis and Ways to Improve Outcomes

  https://e-enm.org/journal/view.php?number=1752

  Although the MDRD equation is used widely to screen and monitor for CKD, including diabetic kidney disease, it has been reported to underestimate the renal function in some populations, especially in patients with near-normal renal function. […] Given this limitation, other candidate markers have been evaluated to enable more accurate predictions of GFR. […] The current KDIGO guidelines recommend that both albuminuria and GFR be monitored annually. […] New biomarkers other than albuminuria and GFR are being investigated with the hope of overcoming the limitations of current diagnostic tools for diabetic nephropathy. […] Early and timely assessment with simple diagnostic modalities is beneficial for identifying and managing diabetic nephropathy. […] Many investigators are now focusing on early biomarkers to predict kidney damage beyond albuminuria. […] Furthermore, the combination of novel therapies and well-established conventional treatments might reduce the tremendous burden associated with diabetic nephropathy.

• #1 Current Challenges in Diabetic Nephropathy: Early Diagnosis and Ways to Improve Outcomes

  https://e-enm.org/journal/view.php?number=1752

  To improve the lives of people with diabetic nephropathy and to reduce the impact on society, early identification of the development or progression of diabetic nephropathy using appropriate screening and diagnostic tools is very important in order to provide timely and proper management. […] Identifying and monitoring diabetic nephropathy primarily involves two diagnostic modalities: assessment of kidney function in terms of estimated glomerular filtration rate (eGFR) and estimation of kidney damage in terms of albuminuria. […] These methods are now used world-wide as clinical markers of diabetic nephropathy in real practice. […] Albuminuria is considered as a sensitive marker of chronic kidney disease (CKD) and CVD risk and is used as the first clinical indicator of diabetic kidney disease.

• #1 Diabetes-Related Nephropathy: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/24183-diabetic-nephropathy

  Diabetes-related nephropathy is common. Its the most common cause of end-stage renal (kidney) disease in the world. […] Diabetes-related nephropathy symptoms usually dont appear until it has affected at least 80% to 90% of your kidneys. […] If your healthcare provider suspects you may have diabetes-related nephropathy, they may order tests. […] The following tests help diagnose diabetes-related nephropathy: […] Treatment depends on what stage youre in, your age and your overall health. […] No, you cant reverse diabetes-related kidney damage. But you can slow down or even stop further kidney damage by taking medications as prescribed by your healthcare provider, eating well and being physically active. […] If you have advanced diabetes-related kidney disease, treatment options include:

• #1 Diabetic nephropathy: symptoms, causes and treatment

  https://mydr.com.au/diabetes/diabetic-nephropathy/

  Blood tests are also recommended to check your kidney function. The level of creatinine, a waste product in the blood, can be measured to calculate your estimated glomerular filtration rate (eGFR). The eGFR gives an indication of how well the kidneys are working to filter waste products from your blood. […] It is usually recommended that people with diabetes have blood and urine tests at least once a year to check on kidney function. […] Early detection and treatment of diabetic nephropathy can not only stop the progression of kidney disease in people with diabetes, but during the early stages can actually reverse it. Treatment involves controlling both your blood glucose levels and your blood pressure. […] People with type 2 diabetes who have microalbuminuria or proteinuria (evidence of some degree of diabetic nephropathy) are usually also treated with medicines called angiotensin-converting enzyme inhibitors (ACE inhibitors) or angiotensin receptor blockers (ARBs). […] You should also have a kidney health check (which involves having a urine test, blood test and blood pressure test) at least once a year to check how well your kidneys are functioning.

• #1 Diabetic Nephropathy: Symptoms, Causes, and Treatment Guide | Sparsh Hospital

  https://www.sparshhospital.com/blog/what-is-diabetic-nephropathy/

  Managing diabetic nephropathy effectively involves controlling blood sugar levels and blood pressure. Adopting a kidney-friendly diet, staying physically active, avoiding smoking, and reducing salt and protein intake can slow its progression. Medications, such as ACE inhibitors or angiotensin receptor blockers (ARBs), may also be prescribed to protect kidney function. […] While nephropathy is not fully curable, it is possible to slow its progression significantly with proper management. Early detection and treatment can help protect kidney function, prevent complications, and reduce further damage to the kidneys. […] Recovery from diabetic nephropathy depends on the stage of the disease. In its early stages, kidney damage can sometimes be reversed or stabilized with effective treatment. However, in more advanced stages, the focus shifts to managing symptoms and preventing further kidney damage.

• #1 Diabetes Canada | Clinical Practice Guidelines

  https://guidelines.diabetes.ca/cpg/chapter29

  The eGFR is useful for assessing chronic changes in renal function but should not be used in situations where kidney function is changing rapidly. […] Optimal glycemic control established as soon after diagnosis as possible will reduce the risk of development of diabetic kidney disease. […] Optimal BP control also appears to be important in the prevention and progression of CKD in diabetes, although the results have been less consistent. […] Blockade of the renin angiotensin aldosterone system (RAAS) with either an angiotensin converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB) can reduce the risk of developing CKD in diabetes independent of their effect on BP. […] Most people with CKD and diabetes will not require referral to a specialist in renal disease and can be managed in primary care. However, specialist care may be necessary when renal dysfunction is severe, when there are difficulties implementing renal-protective strategies or when there are problems managing the sequelae of renal disease.

• #1 Diagnosis of diabetic kidney disease: state of the art and future perspective

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6336222/

  In conclusion, the diagnosis of diabetic kidney disease relies on measurement and monitoring of urinary albumin excretion (i.e., ACR) and renal function (i.e., eGFR) in combination with clinical assessment. This guides classification, prognosis, and therapy but, although recommended in most guidelines, is still not fully implemented in global diabetes care.

• #2 Diabetic nephropathy: Symptoms, stages, causes, and treatment

  https://www.medicalnewstoday.com/articles/319686

  Diabetic nephropathy is a long-term kidney disease that can affect people with diabetes. It occurs when high blood glucose levels damage how a persons kidneys function. […] Diabetic nephropathy is a kind of chronic kidney disease (CKD). […] Diabetic nephropathy is a major cause of long-term kidney disease and end-stage renal disease (ESRD). […] Diabetic nephropathy is a possible complication of diabetes. […] Authors of a study from 2016 note that 20-40% of people with diabetes develop some kind of kidney disease. […] Tests may show that a person has one or both of the following: High levels of albumin in the urine: When the kidneys are healthy, the urine should contain none of the protein known as albumin. […] A low glomerular filtration rate (GFR): A key function of the kidneys is to filter the blood.

• #2 Diabetic nephropathy (kidney disease) – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diabetic-nephropathy/symptoms-causes/syc-20354556

  Diabetic nephropathy is a serious complication of type 1 diabetes and type 2 diabetes. It’s also called diabetic kidney disease. […] Diabetic kidney disease can lead to kidney failure. This also is called end-stage kidney disease. Kidney failure is a life-threatening condition. Treatment options for kidney failure are dialysis or a kidney transplant. […] Make an appointment with your health care professional if you have symptoms of kidney disease. If you have diabetes, visit your health care professional yearly or as often as you’re told for tests that measure how well your kidneys are working. […] Diabetic nephropathy happens when diabetes damages blood vessels and other cells in the kidneys. […] Diabetic nephropathy is a common complication of type 1 and type 2 diabetes. […] Over time, diabetes that isn’t well controlled can damage blood vessels in the kidneys that filter waste from the blood. This can lead to kidney damage and cause high blood pressure.

• #2 Diabetic nephropathy: Diagnosis, screening and management – DiabetesontheNet

  https://diabetesonthenet.com/diabetes-primary-care/diabetic-nephropathy-diagnosis-screening-and-management-1/

  Diabetic nephropathy remains the most common cause of end-stage renal failure and is associated with increased cardiovascular morbidity and mortality. […] Early identification and evidence-based intervention are critical to prevent development and to slow progression. […] Albuminuria is thus the earliest clinical feature of nephropathy. […] The detection of albuminuria is the cornerstone of diagnosis of nephropathy. […] At diagnosis, GFR can be elevated in people with type 1 or 2 diabetes. […] The rate of decline thereafter determines the progression of nephropathy and likely timing of end-stage renal disease (ESRD) requiring renal replacement therapy. […] This estimated GFR has been used as a basis for diagnosis and staging of chronic kidney disease (CKD). […] The presence of retinopathy in a person with diabetes and albuminuria makes a diagnosis of diabetic nephropathy almost certain. […] Nephropathy is a serious complication of diabetes and is associated with significant mortality and comorbidity. However, there is a strong evidence base for therapies that can prevent development and slow its progression.

• #2 Current Challenges in Diabetic Nephropathy: Early Diagnosis and Ways to Improve Outcomes

  https://e-enm.org/journal/view.php?number=1752

  Measuring the quantity of albumin in a 24-hour urine collection has been considered the gold standard for the diagnosis of diabetic nephropathy. […] Recently, guidelines recommend the use of the albumin-to-creatinine ratio (ACR) of a spot urine sample, a technique that can be performed easily in the clinic setting as a surrogate for the amount of urinary albumin in a 24-hour urine collection. […] The American Diabetes Association (ADA) recommends that a patient is considered to have albuminuria when at least two of three measurements of urine ACR examined within 6 months are abnormal. […] The rate of progression from category A2 to category A3 is predicted to be 2% to 3% per year, and this progression is associated with a decrease in glomerular filtration rate (GFR). […] Persistently and moderately increased urinary ACR (A2) is an index of development of diabetic kidney disease and is also a well-established indicator of increased CVD risk.

• #2 Diabetic Nephropathy – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK534200/

  Diabetic nephropathy is the leading cause of end-stage renal disease in developed countries, including the United States. As a microvascular complication, it affects individuals with both type 1 and type 2 diabetes. […] Traditional markers of DKD, such as albuminuria and creatinine, are relatively insensitive and have limited utility due to delayed detection. […] Diagnosis involves albuminuria assessment, with thresholds for moderate and severe stages. […] Diabetic nephropathy is diagnosed by persistent albuminuria on 2 or more occasions, separated by at least 3 months, using early morning urine samples. Persistent albuminuria is defined as 300 mg/d or greater. […] Moderately increased albuminuria, a marker of early diabetic nephropathy, is between 30 and 300 mg over 24 hours. […] Severe albuminuria is classified as greater than 300 mg of albuminuria per day.

• #2 Diabetic Nephropathy Workup: Approach Considerations, Urinalysis, Blood Tests

  https://emedicine.medscape.com/article/238946-workup

  Microalbuminuria is defined as albumin excretion of more than 20 g/min or an albumin-to-creatinine ratio (g/g) of greater than 30. This phase indicates incipient diabetic nephropathy and calls for aggressive management, at which stage the disease may be potentially reversible (ie, microalbuminuria can regress). […] Blood tests, including calculation of GFR (by various formulas, such as the MDRD formula), are helpful in monitoring for the progression of kidney disease and in assessing its stage. […] Renal biopsy is not routinely indicated in all cases of diabetic nephropathy, especially in persons with a typical history and a progression typical of the disease. It is indicated if the diagnosis is in doubt, if other kidney disease is suggested, or if atypical features are present. […] The following three major histologic changes occur in the glomeruli of persons with diabetic nephropathy: First, mesangial expansion is directly induced by hyperglycemia, perhaps via increased matrix production or glycosylation of matrix proteins. Second, thickening of the glomerular basement membrane (GBM) occurs. Third, glomerular sclerosis is caused by intraglomerular hypertension (induced by renal vasodilatation or from ischemic injury induced by hyaline narrowing of the vessels supplying the glomeruli).

• #2 Diabetic kidney disease – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/530

  Diabetic kidney disease (DKD) is usually a clinical diagnosis in a patient with long-standing diabetes (10 years) with albuminuria and/or reduced estimated glomerular filtration rate (eGFR) in the absence of signs or symptoms of other primary causes of kidney damage. […] The diagnosis of DKD is most conclusively made by findings of mesangial expansion and nodular glomerulosclerosis on kidney biopsy, though kidney biopsy is rarely necessary. […] 1st investigations to order include urinalysis, urinary albumin to creatinine ratio (ACR), serum creatinine with GFR estimation, and kidney ultrasound. […] Investigations to consider include cystatin C with GFR estimation, albumin excretion rate (AER), CT abdomen, magnetic resonance angiography (MRA), Doppler ultrasound, and kidney biopsy.

• #2 Diabetic Nephropathy | Kidney Disease

  https://health.ucdavis.edu/conditions/kidney-disease/kidney-damage/diabetic-nephropathy

  Whether you need nutritional support, medications or a kidney transplant, were ready to help you. Our program provides the most advanced therapies available for diabetic kidney disease. […] At UC Davis Health, our highly trained nephrologists specialize in kidney care for people with diabetes. […] Diabetic nephropathy is chronic kidney disease from diabetes. People also call it diabetic kidney disease or DKD. This complication affects about 30-40% of all people with type 1 or type 2 diabetes. Without treatment, DKD can lead to permanent kidney damage and kidney failure. […] Our goal is to help you live well with diabetes, so we regularly check your blood and urine for signs of kidney problems. You may have diabetic nephropathy if your urine tests show the presence of the protein albumin. Then, we explain your test results and answer your questions. […] Diabetic nephropathy is preventable. You can help prevent kidney damage if you: […] Diabetic nephropathy is the #1 cause of end-stage kidney disease. […] 170 people start treatment for kidney failure due to diabetic nephropathy. […] Nearly 50% of all people with kidney disease have diabetes.

• #2 Diabetic kidney disease – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/530

  Diabetic kidney disease (DKD) is usually a clinical diagnosis in a patient with long-standing diabetes (10 years) with albuminuria and/or reduced estimated glomerular filtration rate (eGFR) in the absence of signs or symptoms of other primary causes of kidney damage. […] The diagnosis of DKD is most conclusively made by findings of mesangial expansion and nodular glomerulosclerosis on kidney biopsy, though kidney biopsy is rarely necessary. […] Key diagnostic factors include hypertension, signs of retinopathy, and edema. […] 1st tests to order include urinalysis, urinary albumin to creatinine ratio (ACR), serum creatinine with GFR estimation, and kidney ultrasound. […] Other cause(s) of CKD should be considered in the presence of rapidly increasing albuminuria or nephrotic syndrome, rapidly decreasing eGFR, active urinary sediment, the absence of diabetic retinopathy in patients with type 1 diabetes, or signs or symptoms of other systemic disease.

• #2 Diabetic nephropathy (kidney disease)

  https://johnsonmemorial.org/jmh-health-information-library-disease/con-20203560

  Other diagnostic tests may include: […] Imaging tests. X-rays and ultrasound can show the makeup and size of the kidneys. CT and MRI scans can show how well blood is moving within the kidneys. You may need other imaging tests, as well. […] Kidney biopsy. This is a procedure to take a sample of kidney tissue to be studied in a lab. It involves a numbing medicine called a local anesthetic. A thin needle is used to remove small pieces of kidney tissue.

• #2 Diabetic Nephropathy – Genitourinary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/genitourinary-disorders/glomerular-disorders/diabetic-nephropathy

  Diabetic nephropathy is glomerular sclerosis and fibrosis caused by the metabolic and hemodynamic changes of diabetes mellitus. Diagnosis is based on history, physical examination, urinalysis, and urine albumin/creatinine ratio. […] The diagnosis is suspected in patients with diabetes who have proteinuria, particularly if they have diabetic retinopathy (indicating small vessel disease) or risk factors for diabetic nephropathy. […] Yearly screening of all patients with diabetes with random urine albumin/creatinine ratio. […] Patients are tested for proteinuria by routine urinalysis; if proteinuria is present, testing for microalbuminuria is unnecessary because the patient already has macroalbuminuria suggestive of diabetic kidney disease. […] For most patients with diabetes who have proteinuria, the diagnosis is clinical. Renal biopsy can confirm the diagnosis but is rarely necessary.

• #2 Diabetic Nephropathy: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/238946-overview

  Diabetic nephropathy is characterized by the following: Persistent albuminuria (300 mg/d or 200 g/min) that is confirmed on at least two occasions 3-6 months apart. A relentless decline in the glomerular filtration rate (GFR). Elevated arterial blood pressure. […] Several issues are key in the medical care of patients with diabetic nephropathy. These include glycemic control, management of hypertension, and reducing dietary salt intake and phosphorus and potassium restriction in advanced cases. […] The exact cause of diabetic nephropathy is unknown, but various postulated mechanisms are hyperglycemia (causing hyperfiltration and renal injury), advanced glycation products, and activation of cytokines. […] Diabetic nephropathy rarely develops before 10 years duration of type 1 DM. Approximately 3% of newly diagnosed patients with type 2 DM have overt nephropathy.

• #2 What tests can screen for diabetes-related nephropathy?

  https://www.medicalnewstoday.com/articles/screening-for-diabetes-related-nephropathy

  Diabetes-related nephropathy is a potential complication of diabetes. Tests to help screen for nephropathy include urine protein tests, imaging tests, kidney biopsy, and glomerular filtration rate. […] Diabetes-related nephropathy or diabetic kidney disease is a common complication of diabetes, including diabetes type 1 (T1D) and diabetes type 2 (T2D). […] A doctor will recommend several screening tests because there is currently no cure for diabetes-related nephropathy. These tests can help detect the onset of the condition, which can assist in managing the condition. […] A 2021 review indicates that diabetes-related nephropathy usually occurs without symptoms in its early stages, and many people remain without diagnosis and treatment. This is why it is advisable for those with diabetes to have regular annual checks, including tests for kidney health.

• #2 Diabetic Nephropathy: Symptoms, Causes, Diagnosis and treatment PACE Hospitals – Best Hospitals in Hitech City, Hyderabad, India | Near Madhapur, Kukatpally, KPHB, Kondapur, Gachibowli, Jubilee Hills, Banjara HillsPACE Hospitals Contact N

  https://www.pacehospital.com/diabetic-nephropathy

  Diabetic Nephropathy or Diabetic Kidney Disease is a type of kidney disease that occurs in some people who have diabetes. […] Leading cause of kidney disease is diabetes, 30 percent of patients with Type 1 diabetes and 10 to 40 percent of those with Type 2 diabetes suffer from Diabetic kidney disease. […] Initial stage there are often no symptoms. The early sign of diabetic kidney disease is an increased excretion of albumin in the urine, we advise all to do yearly checkup so that Diabetic Nephropathy can be identified in initial stages. […] The prevalence of DN is mostly in Type 2 diabetic patients, 20-40% with microalbuminuria (MA) progress to manifested nephropathy after 20 years from the onset of diabetes; approximately 20% develop end-stage renal disease (ESRD). […] It is recommended that all Type 2 diabetic patients should do annual microalbuminuria urine test, starting at the time of diagnosis.

• #2 Diagnosis, Prevention and Treatment in Diabetic Nephropathy | Frontiers Research Topic

  https://www.frontiersin.org/research-topics/25739/diagnosis-prevention-and-treatment-in-diabetic-nephropathy

  Diabetic Nephropathy, or Diabetic Kidney Disease, refers to the deterioration of proper functioning in the kidneys of patients affected by both type 1 and type 2 diabetes. Almost 40% of diabetic patients are affected by this syndrome, increasing their risk of death. Diabetic Nephropathy is defined by increased urinary albumin excretion in absence of other renal diseases. Genetics, glycaemic control, and hypertension are the main factors that can influence kidney disease development. Diabetic nephropathy is divided into five stages of deterioration, with the final one being ESRD. New diagnosis and prevention tools for Diabetic Nephropathy are fundamental, as the symptoms tend to become apparent once the condition has reached later stages. Currently, there is no cure for this syndrome, as therapies and medications focus on slowing down the progression of kidney damage.

• #2 Chronic Kidney Disease: Detection and Evaluation | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/1215/p776.html

  Chronic kidney disease affects 47 million people in the United States and is associated with significant health care costs, morbidity, and mortality. […] Multiple guidelines recommend at least annual screening with serum creatinine, urine albumin/creatinine ratio, and urinalysis for patients with risk factors, particularly diabetes mellitus, hypertension, and a history of cardiovascular disease. […] Persistently elevated serum creatinine and albuminuria are diagnostic and prognostic hallmarks of chronic kidney disease. […] New guidelines incorporate albuminuria into the classification framework for chronic kidney disease and elaborate on identification of the disease, the frequency of follow-up, and recommendations for nephrology referral. […] Nephrology consultation is indicated for patients with an estimated glomerular filtration rate less than 30 mL per minute per 1.73 m2, persistent urine albumin/creatinine ratio greater than 300 mg per g or urine protein/creatinine ratio greater than 500 mg per g, or if there is evidence of a rapid loss of kidney function.

• #3 Diabetic Nephropathy – a Review of Risk Factors, Progression, Mechanism, and Dietary Management

  https://www.biomolther.org/journal/view.html?uid=1312&vmd=Full&

  Diabetic nephropathy (DN) is a major disorder of diabetes mellitus (DM) which ends up in chronic renal failure. People with DM are ten times more prone to end-stage kidney failure. The International Diabetes Federation (IDF) reports that 40% of diabetic people might develop final stage renal failure. Furthermore, diabetes and hypertension, either in combination or separately lead to about 80% of end-stage kidney failure. […] Microalbuminuria is the early evidence for detecting DN. About 20% of patients develop nephropathy from microalbuminuria within a decade and nearly 20% of patients reach end-stage kidney disease. […] Recent developments in diagnostics and therapeutics such as the study of innovative molecules, stem cell therapy, and gene therapies are necessary for the treatment of DN.

• #3 Diabetic Kidney Disease: Diagnosis, Treatment, and Prevention | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0615/p751.html

  Globally, approximately 20% of the 400 million individuals with diabetes mellitus have diabetic kidney disease (DKD). DKD is associated with higher cardiovascular and all-cause morbidity and mortality, so timely diagnosis and treatment are critical. Screening for early DKD is best done with annual spot urine albumin/creatinine ratio testing, and diagnosis is confirmed by repeated elevation in urinary albumin excretion. […] Diagnosis is made clinically when a patient has evidence of kidney disease and no other primary etiology. Early referral to nephrology (at chronic kidney disease stage 3 or 4) may help improve DKD outcomes and should be considered.

• #3 What tests can screen for diabetes-related nephropathy?

  https://www.medicalnewstoday.com/articles/screening-for-diabetes-related-nephropathy

  As diabetic kidney disease does not typically present with symptoms, screening tests, such as blood and urine tests, are the best way to monitor kidney health and help doctors to diagnose the condition. […] Screening is integral to diagnosing, treating, and managing diabetes-related nephropathy since there is currently no cure for the condition. These tests include urine protein tests, estimated glomerular filtration rate (eGFR), imaging, and kidney biopsy. Health experts recommend people living with diabetes receive annual renal screenings to check for kidney problems.

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