Diabetic Nephropathy Flashcards
By time have diabetic nephropathy, usually also will have…
In type 1
Diabetic retinopathy
If absent worry some other process
If type two not necessarily retinopathy
Screen for nephropathy
Type 1 from 5 yrs… If less that this check for active urinary sediment and lupus serology and consider biopsy
Type 2from diagnosis
Normal urine ACRs
Male 2.5 to 25 mg/mol
Female 3.5-35 mg/nmol
Once have it need another 1-2 checks over a three month period
Microalbuminuria is a major risk factor for …
CVD
Trials for ace in type two diabetes and ACE
DETAIL - enalapril vs telmisartan
ADVANCE - perindopril vs placebo
VA NEPHRON trial
Diabetic nephropathy
Losartan and placebo vs loser tan plus losinopril
Not protective
Increase risk AKI and hyperk
On target
Ramipril plus telmisartan vs telmisartan alone
Does good diabetic control slow progression diabetic nephropathy
Probably does