Diabetic nephropathy: which teenagers are at risk and how can risk be minimised

Microalbuminuria is the first marker of renal damage in T1DM but does not invariably progress to diabetic nephropathy and may be reversed in some patients. An annual measurement of albumin to creatinine ratio in an early morning urine sample is recommended, with serial daily samples used to confirm increased excretion and early institution of ACEi and/or AIIrb to treat persistent microalbuminuria. Good glycaemic control from diagnosis is essential for good long term renal function. Aggressive treatment of hypertension reduces the rate of renal decline once diabetic nephropathy is established.