Assessment for markers of nephropathy in newly diagnosed type 2 diabetics

Type 2 diabetics account for a large proportion of patients presenting in end-stage kidney disease (ESKD). Although diabetic renal disease can be predicted, a lot of diabetics present to Nephrologists in ESKD.

To assess for markers of nephropathy in newly diagnosed type 2 diabetics, using blood pressure levels, endogenous creatinine clearance and urinary protein excretion as markers of renal disease.

Ninety newly diagnosed type 2 diabetics were studied within 6 weeks of diagnosis. They were in good glycaemic control during the period of study. Seventy-two age and sex-matched and apparently healthy non-diabetics served as controls. Blood pressure was recorded in all subjects. 24 hours urine sample was collected for estimation of urinary protein excretion and endogenous creatinine clearance.

Systolic and diastolic blood pressures were consistently higher in diabetics than in controls (p=0.001 and p=0.001 respectively). High-normal and midly elevated blood pressure were more prevalent in diabetics (p=0.001). Mean creatinine clearance in diabetics was significantly lower than in non-diabetics (p=0.037). 7 % of diabetics had supra-normal creatinine clearance of >125mls/minute. The prevalence of microproteinuria was 40% in diabetics and 33% in non-diabetics, while macroproteinuria was present in 44% of diabetics but absent in non-diabetics (p=0.000).

High-normal, mildly elevated blood pressure and microproteinuria were commonly encountered in newly diagnosed diabetics studied. The phenomenon of hyperfiltration was present in type 2 diabetics. These tools should be assessed at diagnosis of diabetes as this will help in identifying those who are at an increased risk for developing diabetic nephropathy.