Diagnostic strategy to monitor diabetic nephropathy

Although much evidence supports the theory that microalbuminuria is predictive of the development of clinical diabetic nephropathy, other experimental data fail to support this conclusion. It remains unclear whether random urine samples offer as much clinical information as timed overnight or 24 hour samples. Clinical decisions as to treatment based on improved glycemic control or enhanced antihypertensive treatment should be structured to the urinary albumin concentration. Tubular dysfunction is common in diabetes, but is clinical relevance remains unclear.