Nephrology
Abstract
  • Assessment and management of diabetic albuminuria
    Microalbuminuria is the earliest clinical evidence of nephropathy in diabetic patients. Early detection and intervention can help to slow or even revert the progression to more advanced stages of nephropathy. This article aims to review and discuss recent trends in assessing and management of diabetic albuminuria. In general, urine dipsticks should not be used to identify albuminuria. Albumin to creatinine ratio (ACR) is the preferred test, as it is a validated, more convenient and more accessible method. Patients with microalbuminuria, compared with those with macroalbuminuria, will have different implications in therapeutic interventions. Proteinuria in a diabetic patient may not necessarily be attributable to diabetes.
  • Assessment of proteinuria
    Microalbuminuria can be diagnosed from a 24-hour urine collection (between 30–300 mg/24 hours) or, more commonly, from elevated concentration in a spot sample (20 to 200 mg/L). Both must be measured on at least two of three measurements over a two- to three-month period. To compensate for variations in urine concentration in spot-check samples, it is helpful to compare the amount of albumin in the sample against its concentration of creatinine. This is termed the albumin/creatinine ratio (ACR)[9] and microalbuminuria is defined as ACR ≥3.5 mg/mmol (female) or ≥2.5 mg/mmol (male), Urinary excretion of abnormal quantities of protein for ≥3 months, with or without a decrease in glomerular filtration rate (GFR), is diagnostic of chronic kidney disease. Urine albumin measurement is an important component in screening for chronic kidney disease. The presence of proteinuria is an independent risk factor for cardiovascular disease, death, and end-stage renal disease in the general population, and in patients with chronic kidney disease. Presence of proteinuria is associated with a higher mortality in critically ill patients. Reduction of proteinuria by pharmacological therapy is used as a surrogate marker in the management of chronic kidney disease and many acute glomerular diseases and is associated with improved renal outcomes.
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Patient Information
  • MedlinePlus: Kidney stones
    A kidney stone is a solid mass that consists of a collection of tiny crystals. There can be one or more stones present at the same time in the kidney or in the ureter.
  • UMHS: Kidney stones
    A kidney stone is a solid piece of material that forms in the kidney out of substances in the urine. Stones can occur in any part of the urinary system, from the kidney to the bladder. They may be small or large. You may have just one stone or many.
  • Polycystic kidney disease (PKD)
    In PKD fluid-filled cysts develop giving the kidneys a honeycomb appearance. It is one of the most common inherited disorders, and the fourth commonest cause of kidney failure.
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  • Nephrology Resources
    Most urinary tract stones occur in the upper urinary tract. Their composition varies widely depending upon metabolic alterations, geography and presence of infection. Their size varies from gravel to staghorn calculi.
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