Synopsis
Detect diabetic kidney disease early, recognise atypical features, and layer kidney and cardiovascular protection without avoidable treatment harm.
- Diabetic kidney disease is identified by persistent albuminuria, reduced eGFR or both in a person with diabetes after excluding important alternative explanations.
- Measure urine ACR as well as creatinine because substantial albuminuric risk can exist while eGFR remains normal, and non-albuminuric kidney impairment also occurs.
- Confirm a new abnormal ACR when clinically stable; infection, menstruation, exercise, fever, severe hyperglycaemia and decompensated heart failure can cause transient elevation.
Key red flags
Active urinary sediment, abrupt nephrosis, rapid decline or systemic illness suggests non-diabetic or superimposed kidney disease.
Investigation priorities
Detect and grade albuminuria using a standard quantitative measure.
Management branches
A person with diabetes attends planned review.
- Measure urine ACR and serum creatinine/eGFR at the interval specified for diabetes type and previous results.
- Repeat a new ACR abnormality under stable conditions and compare eGFR with earlier values to establish persistence and slope.
Key medicines
SGLT2 inhibitor for eligible type 2 diabetes and CKDChoose the licensed product and dose from the current NICE recommendation, local formulary, eGFR indication and SmPC; counsel before initiation rather than extrapolating between agents.
FinerenoneUse within NICE TA877 for eligible stage 3 or 4 albuminuric CKD associated with type 2 diabetes after optimised standard care; select and adjust dose using current potassium, eGFR and SmPC rules.