Diabetic Nephropathy Screening (NICE)

Question 1

What tests are done in diabetic nephropathy screening?

Answer 1

eGFR
Urine albumin:creatinine ratio (ACR) (first void)

Question 2

What is the cut off for a normal albumin to creatinine ratio (ACR), and what would be considered moderately increased?

Answer 2

< 3mg/mmol - Normal to mildly increased
3–30mg/mmol - Moderately increased
> 30mg/mmol - Severely increased

Question 3

When is someone with diabetes considered to have CKD?

Answer 3

If the eGFR is less than 60 mL/min/1.73 m2 for 3 months or more
AND/OR
urine ACR greater than 3 mg/mmol, for 3 months or more

Question 4

At what stage of CKD/nephropathy should diabetics be offered atorvastatin 20mg regardless of lipid profile?

Answer 4

CKD 3 or more
AND/OR
urine ACR greater than 3 mg/mmol

Question 5

When would a diabetic be offered an ACEI?

Answer 5

CKD 3 or more
AND/OR
ACR 3mg/mmol or more

Question 6

When should an SGLT2 inhibitor be added to a patient with diabetic nephropathy?

Answer 6

Already on ACEI max dose
AND
ACR >30mg/mmol (can be considered if 3-29)
AND
Not contraindicated (e.g. eGFR too low)

Dapagliflozin licensed for this

Question 7

If renal function is not improved with an ACEI and SGLT2 inhibitor, what drug can be considered?

Answer 7

Finerenone in stage 3-4 CKD
Other drugs must be unsuitable or max dose