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World J Diabetes. May 15, 2010; 1(2): 48-56
Published online May 15, 2010. doi: 10.4239/wjd.v1.i2.48
Renal function in diabetic nephropathy
Pradeep Kumar Dabla
Pradeep Kumar Dabla, Department of Biochemistry, Lady Hardinge Medical College, New Delhi 110001, India
Author contributions: Dabla PK contributed solely to this paper.
Correspondence to: Pradeep Kumar Dabla, MD, Postal Paradise Apartment, Flat-428, Block-E, Pocket-3, Sector-18, Rohini, New Delhi 110085, India.
Telephone: +91-98-68524455
Received: December 25, 2009
Revised: April 25, 2010
Accepted: May 2, 2010
Published online: May 15, 2010

Diabetic nephropathy is the kidney disease that occurs as a result of diabetes. Cardiovascular and renal complications share common risk factors such as blood pressure, blood lipids, and glycemic control. Thus, chronic kidney disease may predict cardiovascular disease in the general population. The impact of diabetes on renal impairment changes with increasing age. Serum markers of glomerular filtration rate and microalbuminuria identify renal impairment in different segments of the diabetic population, indicating that serum markers as well as microalbuminuria tests should be used in screening for nephropathy in diabetic older people. The American Diabetes Association and the National Institutes of Health recommend Estimated glomerular filtration rate (eGFR) calculated from serum creatinine at least once a year in all people with diabetes for detection of kidney dysfunction. eGFR remains an independent and significant predictor after adjustment for conventional risk factors including age, sex, duration of diabetes, smoking, obesity, blood pressure, and glycemic and lipid control, as well as presence of diabetic retinopathy. Cystatin-C (Cys C) may in future be the preferred marker of diabetic nephropathy due differences in measurements of serum creatinine by various methods. The appropriate reference limit for Cys C in geriatric clinical practice must be defined by further research. Various studies have shown the importance of measurement of albuminuria, eGFR, serum creatinine and hemoglobin level to further enhance the prediction of end stage renal disease.

Keywords: Chronic kidney disease, End stage renal disease, Glomerular filtration rate, Estimated glomerular filtration rate, Microalbumin, Cockcroft-Gault formula, Modification of diet, Renal disease, Cystatin-C