Nephropathy

Diabetic nephropathy is the commonest cause of end stage renal disease in the western world. Diagnosis is made on a clinical and biochemical grounds, typically the presence of diabetes for 10-20 years or more, a progressive deterioration in renal function associated with worsening proteinuria, no haematuria, and usually other microvascular complications such as retinopathy or neuropathy. The mainstay of management is anti-hypertensive therapy with ACE-inhibitors and/or angiotensin receptor blockers. Eventually dialysis or transplantation are necessary in a proportion of cases.

What is the blood pressure?

Hypertension is an important risk factor for nephropathy and, if nephropathy has developed, managing blood pressure is the most important factor in attempting to control its progression.

Does the patient have any abnormal physical signs?

There are no specific physical signs of diabetic nephropathy but the presence of overt, dipstick positive proteinuria should always be sought.

Does the patient have peripheral neuropathy?

The presence of established microvascular complication such as peripheral neuropathy increases the likelihood of further microvascular complication such as nephropathy.

Does the patient have diabetic retinopathy? 

The presence of established microvascular complication such as retinopathy increases the likelihood of further microvascular complication such as nephropathy.

Is there any oedema?

Rarely, the proteinuria associated with diabetic nephropathy enters the nephrotic range and frank oedema develops.

Is there asterixis?

Asterixis ('flap') can be a feature of uraemia, although is only seen in advanced nephropathy.

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