For Both Type I and Type II diabetes, as they result from chronic ↑ Hyperglycemia (> 7)

• T1DM
• T2DM

Pathogenesis

• ↑ Hyperglycemia (> 7) + ischemia → attack to blood vessels (glomerulus) → Structural change of glomerulus → chronic Proteinuria → CKD

  

1. Non-enzymatic Glycation of EA → Hyaline arteriolosclerosis → Hyperfiltration → Polyuria

2. Over time, Hypertensive state → Glomerulo-sclerosis

RF

• High Glucose
• High BP

Investigation & Screening

Time of diagnosis

Random

• ACR (<3)

  • 2 = micro-albuminuria

  • 20 = CKD

• eGFR (≥ 60mL/min)
  • < 60 = sign of kidney dysfunction

Follow up

• Repeat annually

DDx

Transient increase in ACR (<3) can be caused by

• Major exercise
• UTI
• Fever
• Decompensated HF - Heart Failure
• Menstruation
• Acute severe elevation of blood glucose
• Acute severe elevation of BP
• Diagnosis Algorithm

Prevention and Treatment

• Medications
• Goals