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Type 2 Diabetes Management Guidelines

Management of diabetic kidney disease

  • Red flags for alternative causes of renal dysfunction in patients with diabetes
  • Short duration of diabetes e.g. < 5 years
  • Young patients e.g. < 30 years of age
  • Persistent decline in eGFR > 1 mL/min per month or > 10 mL/min per year (NB: eGFR is hydration dependent)
  • No evidence of diabetic retinopathy
  • Family history of renal disease
  • Overt features of alternative cause e.g. connective tissue disease, recurrent UTIs, hypertension, casts on MSU
  • Persistent albuminuria is defined by urinary albumin:creatinine ratios (ACR) in the following categories:
    • A1 - 'Normal to mildly increased' - ACR < 3 mg/mmol
    • A2 - 'Moderately increased or microalbuminuria' - ACR 3 - 30 mg/mmol
    • A3 - 'Severely increased or macroalbuminuria' - ACR > 30 mg/mmol
  • Two positive samples are required for the first diagnosis of persistent albuminuria to exclude falsely raised ratios due to:
  • UTI
  • Intercurrent illness
  • Vigorous physical activity
  • Haematuria
  • Significant hyperglycaemia
  • GFR categories are defined by the following categories:
    • G1 -   Normal or high - > 90 mL/min
    • G2 -   Mildly decreased - 60 - 89 mL/min
    • G3a - Mildly to moderately decreased - 45 - 59 mL/min
    • G3b - Moderately to severely decreased - 30 - 44 mL/min
    • G4 -   Severely decreased - 15 - 29 mL/min
    • G5 -   Renal failure
  1. Manage hypertension aggressively

2. Optimise glycaemic control

3. Optimise cardiovascular risk

4. Monitor and review regularly