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Diabetes mellitus
Proteinuria management
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Principles: Once proteinuria is established, renal decline is
inevitable.
Interventions are intended to:
- slow the rate of renal decline
- monitor the rate of renal decline
- result in appropriate use of nephrology services
- limit large and small vessel damage in other systems
People with proteinuria should be aware of
- The benefits of optimum blood pressure control
- The use of serum creatinine to monitor renal decline
- The benefits of reducing other large and small vessel risk factors
Further investigations
Proteinuria usually develops 10 years after the presentation of
microalbuminuria. Other causes of proteinuria should be excluded in
- Those presenting within 5 years of diagnosis of diabetes
- Those with haematuria
- Those presenting with rapid renal decline or associated systemic illness
Slow rate of decline: manage blood pressure aggressively to achieve the
following targets
- 130/75 age>40
- 120/70 age<40
Monitoring decline
- Monitor serum U+E every 4-6 months
- Record serum creatinine on log charts once it rises above 150. This will
allow you to estimate the rate of renal decline
- The rate of decline is more important than the absolute figure in people
with a serum creatinine <250.
- Refer to renal physicians as the serum creatinine approaches 200
Other risk factors
- Optimise glycaemic control to protect eyes
- Treat vascular risk factors aggressively (total cholesterol < 5,
encourage healthy lifestyles, encourage to stop smoking),
Seek (urgent) specialist advice in those
wishing to try for a pregnancy
Source: Northumbria NHS Health Care Trust diabetes protocol