Everyday Practice: Diabetes Mellitus The kidney and the eye in people with diabetes mellitus

In the ongoing series on diabetes mellitus, this article discusses an approach to screen and evaluate patients with diabetes for kidney disease and retinopathy. DIABETIC NEPHROPATHY: DIAGNOSIS, PREVENTION AND MANAGEMENT Nephropathy in a patient with diabetes mellitus is a common, serious and potentially life-threatening microvascular complication. Conventionally, ‘diabetic nephropathy’ is defined as ‘dipstick-positive proteinuria in a patient with long-standing diabetes, due to diabetic glomerulosclerosis, in the absence of other causes of proteinuria’. Proteinuria detectable by ‘dipstick’ examination implies a daily protein loss of >300 mg in the urine. Globally, diabetic nephropathy (DN) is the single most common cause of incident end-stage kidney disease (ESKD), accounting for 30%–40% of patients. The prevalence of DM in adults in metropolitan cities in India is >10%; of these about 30% are likely to develop DN (several million people!).