 |
Diabetes mellitus
Microalbuminuria management
|
Principle: Early intervention in people with microalbuminuria can prevent
progression to overt proteinuria and inevitable renal decline
People with microalbuminuria should be aware of
- Its significance
- Its natural history
- The range of available interventions and their benefits
Significance
- Renal disease affects 30-40% of people with Diabetes, and is a major cause
of renal failure
- Those with renal changes are at increased risk of developing high blood
pressure, heart disease, peripheral vascular disease, strokes and eye
changes.
Natural history of diabetic renal disease
- Microalbuminuria usually presents during the second decade of
diabetes
- In the absence of intervention, proteinuria usually develops after a
fijrther 10 years
- Once proteinuria is present, renal decline is inevitable
Range of proven interventions
- Optimising Glycaemic control (BM 4-7, HbAI c<7.0)
- Treating elevated blood pressure aggressively
- Using ACE inhibitors to the maximum tolerated dose regardless of blood
pressure readings
- In those with microalbuminuria hypertension is defined using centile
charts. Treatment should be started if readings are >130/75 in those over
the age of 40 and > 120/70 in those under the age of 40
Benefits of interventions
- Early intervention can prevent progression from microalbuminuria to overt
proteinuria
- Aggressive treatment of blood pressure in people with proteinuria can slow
the rate of renal decline
- Aggressive treatment of blood sugars can help to protect eyes in people
with diabetes related renal changes
Source: Northumbria NHS Health Care Trust diabetes protocol