- 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) 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.
- Diabetic Nephropathy Clinical Support – an iPad apps on diabetic nephropathy
Diabetic Nephropathy Clinical Support is a mobile apps on ipad platform, designed to help doctors and other care providers in the management of diabetic nephropathy.
- Renal World
Renal World is a website with focus on kidney diseases. A big library of online calculators for general clinical purposes, GFR estimations, for use in clinical nephrology,
CME Sites (with Credits)
- Nephron Information Centre
Nephron Information Centre is a resourceful repository website on kidney diseases. It aims to provide up-to-date information to public, patients and professionals.
- HDCN - Hypertension, dialysis and clinical nphrology
Hypertension, Dialysis, and Clinical Nephrology is a resourceful website intended for physicians who treat patients with kidney or renal disease.
a medical information website developed and monitored by board-certified physicians, it provides comprehensive, information about conditions that affect the kidneys, such as kidney cancer and nephrotic syndrome, as well as procedures, such
- MDLinx : radiology
a unique mdlink interface for the Medline database, and regularly updated news briefings from Medical Journals.
- Alzheimers's Disease
FAQ, Risk Fators, symptoms and healthy choices about Alzheimer will be shown. Resources, Research information are also avialble at the website.
- Advances in Chronic Kidney Disease
Each bimonthly issue of Advances in Chronic Kidney Disease presents focused review articles devoted to a single topic of current importance in clinical nephrology and related fields.
- American Journal of Kidney Diseases
The American Journal of Kidney Diseases (AJKD), the official journal of NKF, is recognized worldwide as a leader in clinical nephrology content. AJKD publishes original investigations describing the latest findings related to kidney diseases, hypertension, dialysis therapies, and kidney transplantation.
- Journal of Nephrology
J Nephrol publishes original manuscripts dealing with investigations of relevance to the fields of Nephrology, Dialysis and Transplantation
- he Hong Kong Journal of Nephrology i
The Hong Kong Journal of Nephrology is the official peer-reviewed publication of the Hong Kong Society of Nephrology.
- Journal of the American Society of Nephrology
The Journal of the American Society of Nephrology (Print ISSN: 1046-6673; Online ISSN: 1533-3450) is an official publication of the American Society of Nephrology. There is one volume per year beginning in January.
- The Merck Manual: Acute Renal Failure
describes the classification and etiology, the pathophysiology of different types, the symptoms and signs, the diagnosis, prognosis, prophylaxis and treatment aspects of acute renal failure.
- www.edren.org Website of the Edinburgh Renal Unit
Information provided here is for patients, for doctors who are not renal specialists, and for anyone else who is interested in kidney diseases. Below is an alphabetical list of our individual information pages,en.org/pages/handbooks/unit-handbook.php
Organizations / Associations / Institutions
- National kidney foundation (NKF)
National Kidney Foundation is a non profit health organization dedicated to the prevention of kidney and urinary tract diseases,
- The Kidney Foundation of Canada
The Kidney Foundation of Canada is the national volunteer organization committed to funding and stimulating innovative research; providing education and support; and increasing public awareness and organ donation
- Alzheimer’s Association
Home page for the Alzheimer’s Association. Provides information and resources.
- 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.
- Chronic Kidney Disease: A Guide to Select NKF KDOQI Guidelines and Recommendations 2006
Chronic Kidney Disease: A Guide to Select NKF KDOQI Guidelines and Recommendations 2006 was developed in collaboration with Nephrology Pharmacy Associates, Inc. It contains key guidelines and recommendations for the care of patients with chronic kidney disease (CKD) based on KDOQI guidelines published through 2006.
- CLINICAL PRACTICE GUIDELINE Planning, Initiating and Withdrawal of Renal Replacement Therapy
UK Renal Association 6th Edition Draft Version (Feb 2013)
- joint guidelines by UK Renal Association
‘The Renal Association produces joint guidelines with other professional bodies for renal related diseases, treatments or technologies. - See more at: http://www.renal.org/guidelines/joint-guidelines#sthash.OzO0U9aQ.dpuf
- Chronic Kidney Disease in Diabetes
Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. The chapter includes a new, simplified definition of microalbuminuria of albumin to creatinine ratio (ACR) ≥2.0 mg/mmol for both men and women,and there is a new algorithm for screening for chronic kidney disease in adults.
- KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease
All measures that reduce albuminuria as amelioration of insulin sensitivity, weight loss, blood pressure reduction, normalization of blood glucose levels and RAS inhibitor therapy may help to prevent or delay end organ damage. Albumin excretion varies with respect to factors such as: time of day - overnight rates being lower exercise - excretion increased disease such as hypertension - excretion rate increased in some patients
Related Link Lists
- 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.
- Hand Assisted Laparoscopic Radical Nephrectomy (webcast)
The Webcast will feature live Internet transmission of the procedureat Tufts-New England Medical Center in Boston on a hand-assisted laparoscopic radical nephrectomy by OR Live on Wednesday, July 25th at 6:30 p.m.