Diabetic kidney disease biomarkers.
Diabetic kidney disease is usually a diagnosis made based on the presence albuminuria and/or reduced eGFR in the absence of signs or symptoms of other primary causes of kidney damage. At least once a year you should have your practitioner assess urinary albumin and estimated glomerular filtration rate in patients with type 1 diabetes with duration of ≥5 years in all patients with type 2 diabetes and in patients with co morbid hypertension. Patients should be referred for evaluation for renal replacement treatment if they have an estimated glomerular filtration rate <30 mL/min/1.73 m2.
The ADA states within Diabetes Care that “because of biological variability in urinary albumin excretion, two of three specimens of UACR collected within a 3- to 6-month period should be abnormal before considering a patient to have albuminuria. Exercise within 24 h, infection, fever, congestive heart failure, marked hyperglycemia, menstruation, and marked hypertension may elevate UACR independently of kidney damage.” For people with nondialysis-depended diabetic kidney disease, dietary protein intake should be approximately 0.8 g/kg body weight per day as compared with higher levels of dietary protein intake, this level slowed GFR decline with evidence of a greater effect over time.
Should people with kidney disease be on a low protein diet?
The ADA also adds in guidelines published in Diabetes Care that “reducing the amount of dietary protein below the recommended daily allowance of 0.8 g/kg/day is not recommended because it does not alter glycemic measures, cardiovascular risk measures, or the course of GFR decline.”
We need protein to build immunoglobulins for a better immune system. While juicing can be valuable for short periods of time - we need protein to maintain our biological system.
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I.V. Ozone is another modality that is well-researched for kidney disease.
1. When there are no signs or symptoms of other primary causes of kidney damage, diabetic kidney disease is indicated by the presence of __________.
B. Reduced estimated glomerular filtration rate (eGFR)
C. A and/or B
D. None of the above
2. The American Diabetes Association (ADA) recommends that clinicians assess urinary albumin and eGFR in __________ at least once a year.
A. All patients with co morbid hypertension
B. All patients with type 2 diabetes
C. Patients with type 1 diabetes with duration of ≥5 years
D. All of the above
E. None of the above
3. True or False. Patients with eGFR of less than 30 mL/min/1.73 m2 should be referred for evaluation for renal replacement treatment, according to the ADA.\
4. Which of the following statements is/are TRUE regarding urinary albumin–to–creatinine ratio (UACR)?
A. A single abnormal UACR specimen finding within a 3 to 6 month period is sufficient for albuminuria diagnosis
B. UACR may be elevated due to congestive heart failure, rather than by kidney damage
C. UACR may be elevated due to hypertension, rather than by kidney damage
D. A and C
E. B and C
5. True or False. For patients with nondialysis-dependent diabetic kidney disease, the ADA indicates that reducing dietary protein intake below the recommended daily allowance of 0.8 g/kg/day will further slow GFR decline.
1. C. A and/or B
2. D. All of the Above
3. A. True
4. D. B and C
5. B. False
For complete information, see:
American Diabetes Association. Microvascular complications and foot care. Sec. 10. In: Standards of Medical Care in Diabetes – 2017. Diabetes Care. 2017;40(Suppl. 1): S88–S98.