GuidelinesPEML (Paeds Hospital STG)
Diabetic Nephropathy
Diabetic Nephropathy
General and supportive measures
ICD-10 Code: E10.2
DIAGNOSTIC CRITERIA
- Persistent micro-albuminuria:
- Three specimens over a 3–6 month period all show increased albumin: creatinine ratio on a spot urine:
- males: > 2.5 mg/mmol,
- females: > 3.5 mg/mmol.
- Three specimens over a 3–6 month period all show increased albumin: creatinine ratio on a spot urine:
- Screening for micro-albuminuria should start from:
- prepubertal children: 5 years post diabetes diagnosis.
- pubertal children: 2 years post diabetes diagnosis.
GENERAL AND SUPPORTIVE MEASURES
- Optimise diabetes control.
- Monitor blood pressure.
MEDICINE TREATMENT
If urinary albumin:creatinine ratio is persistently above reference range for sex:
- ACE inhibitor, e.g.:
- Enalapril, oral, 0.1 mg/kg/dose as a single dose or two divided doses.
- Maximum dose: 0.5 mg/kg or 40 mg/day.
Note: Exclude non-diabetic nephropathy.
Note: Discuss patient with an endocrinologist or nephrologist if there is a poor response to ACE inhibitor and improved glycaemic control.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 7: Endocrine, 7.5 Diabetes Mellitus, 7.5.2 Diabetes Mellitus, Insulin Dependent: Acute Complications, 7.5.2.4 Diabetic Nephropathy