Diabetic Nephropathy Clinical Presentation

Updated: May 03, 2018
  • Author: Vecihi Batuman, MD, FASN; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Presentation

History

Diabetic nephropathy should be considered in patients who have diabetes mellitus (DM) and a history of one or more of the following:

  • Passing of foamy urine

  • Otherwise unexplained proteinuria

  • Diabetic retinopathy

  • Fatigue and foot edema secondary to hypoalbuminemia (if nephrotic syndrome is present)

  • Other associated disorders such as peripheral vascular occlusive disease, hypertension, or coronary artery disease

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Physical Examination

Generally, diabetic nephropathy is considered after a routine urinalysis and screening for microalbuminuria in the setting of diabetes. Patients may have physical findings associated with long-standing diabetes mellitus, such as the following:

  • Hypertension

  • Peripheral vascular occlusive disease (decreased peripheral pulses, carotid bruits)

  • Evidence of diabetic neuropathy in the form of decreased fine sensations and diminished tendon reflexes

  • Evidence of fourth heart sound during cardiac auscultation

  • Nonhealing skin ulcers/osteomyelitis

Almost all patients with nephropathy and type 1 DM demonstrate signs of diabetic microvascular disease, such as retinopathy and neuropathy. [15] Clinical detection of the retinopathy is easy, and in these patients the condition typically precedes the onset of overt nephropathy. The converse is not true. Only a minority of patients with advanced retinopathy have histologic changes in the glomeruli and increased protein excretion that is at least in the microalbuminuric range, and most have little or no renal disease (as assessed by renal biopsy and protein excretion).

Patients with type 2 DM who have marked proteinuria and retinopathy typically have diabetic nephropathy, while those persons who do not have retinopathy frequently exhibit nondiabetic glomerular disease.

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