19
Î For people with diabetes and diabetic kidney disease (albuminuria
>30 mg/24 h), reducing the amount of dietary protein below usual
intake is NOT recommended because it does not alter glycemic
measures, CV risk measures, or the course of GFR decline. (A)
Î When ACE inhibitors, ARBs, or diuretics are used, monitor serum
creatinine and potassium levels for the development of increased
creatinine or changes in potassium. (E)
Î Continue monitoring urine albumin excretion to assess both response
to therapy and progression of disease. (E)
Î When GFR <60 mL/min/1.73 m
2
, evaluate and manage potential
complications of chronic kidney disease (CKD). (E)
Î Consider referral to a physician experienced in the care of kidney
disease when there is uncertainty about the etiology of kidney disease,
difficult management issues, or advanced kidney disease. (B)
Table 11. Definitions of Abnormalities in Albumin Excretion
Category Spot Collection (mcg/mg creatinine)
Normal <30
Increased urinary albumin excretion
a
≥30
a
Historically, ratios between 30 and 299 have been called microalbuminuria and those ≥300 have
been called macroalbuminuria (or clinical albuminuria).
Table 12. Stages of CKD
Stage Description
GFR
(mL/min per 1.73 m
2
body surface area)
1 Kidney damage
a
with normal or increased
GFR
≥90
2 Kidney damage
a
with mildly decreased GFR 60-89
3 Moderately decreased GFR 30-59
4 Severely decreased GFR 15-29
5 Kidney failure <15 or dialysis
a
Kidney damage defined as abnormalities on pathologic, urine, blood, or imaging tests.
Adapted from Levey AS, Coresh J, Balk E, et al. National Kidney Foundation. National Kidney
Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification.
Ann Intern Med. 2003;139:137-147.
