1. Diabetes-related nephropathy affects 40% of patients with type 1 disease and 10-20% of those with type 2 disease of 20 or more years duration. Microalbuminuria of 30 to 300 mg/24 hours heralds the onset of nephropathy. Microalbuminuria can be detected with annual urine screening for albumin/creatinine ratio. Abnormal screening test results should be confirmed, and a 24-hour urine sample should be obtained for total microalbuminuria assay and evaluation for creatinine clearance.
2. The clinical progression of nephropathy can be slowed by (1) administering ACE inhibitors, such as lisinopril, enalapril or captopril (Capoten), (2) controlling blood pressure to 130185 mm Hg or lower, (3) promptly treating urinary tract infections, (4) smoking cessation, and (5) limiting protein intake to 0.6 g/kg/day.
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