Assessment of kidney function in type 2 diabetes

　　Date written: April 2009

　　Final submission: April 2009

　　Author: Chadban S, Howell M, Twigg S, Thomas M, Jerums G, Cass A, Campbell D, Nicholls K, Tong A, Mangos G,

　　Stack A, MacIsaac RJ, Girgis S, Colagiuri R, Colagiuri S, Craig J

　　GUIDELINES

　　Kidney status in people with type 2 diabetes should be assessed by: (Grade B)*

　　a. Annual screening for albuminuria by:

　　Albumin Excretion Rate (AER) – timed urine collection.

　　Microalbuminuria is indicated by:

　　AER 30–300 mg/24 h or

　　AER 20–200 mg/min in timed collection

　　Macroalbuminuria is indicated by:

　　AER> 300 mg/24 h or

　　AER> 200 mg/min in timed collection OR

　　Albumin: Creatinine Ratio (ACR) – spot urine sample.

　　Microalbuminuria is indicated by:

　　ACR 2.5–25 mg/mmol in males

　　ACR 3.5–35 mg/mmol in females

　　Macroalbuminuria is indicated by:

　　ACR> 25 mg/mmol in males

　　ACR> 35 mg/mmol in females

　　If AER or ACR screening is positive for microalbuminuria:

　　Perform additional ACR or AER measurements one to two times within 3 months. Microalbuminuria

　　is confirmed if at least two of three tests (including the screening test) are positive.

　　If AER or ACR screening is positive for macroalbuminuria:

　　Perform a 24 h urine collection for quantitation of protein excretion.

　　AND

　　b. Annual estimation of the Glomerular Filtration Rate (eGFR).

　　eGFR < 60 mL/min per 1.73 m

　　2

　　indicates at least moderate kidney dysfunction (Stage 3–5 chronic kidney disease [CKD]).

　　eGFR 60–90 mL/min per 1.73 m

　　may indicate mild kidney dysfunction (Stage 2 CKD if albuminuria also present).

　　Continue annual screening for albuminuria and eGFR in the event of negative screening tests.

　　*Refer to Table A1: Definition of NHMRC grades of recommendation. Also refer to NHMRC ‘National Evidence Based Guidelines for

　　Diagnosis, Prevention and Management of Chronic Kidney Disease in type 2 diabetes’ (see http://www.cari.org.au) for Levels of Evidence

　　and Evidence Grading which were undertaken in accordance with the NHMRC Hierarchy of Evidence procedure.

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