1st order laboratory parameters – obligatory laboratory tests.
- Small blood count (hemoglobin* , hematocrit* ).
- Fasting glucose (fasting blood glucose).
- HbA1c (long-term blood glucose value)
- Urine status (rapid test for: pH, leukocytes, nitrite, protein, glucose, ketone, blood), sediment, if necessary urine culture (pathogen detection and resistogram, that is, testing suitable antibiotics for sensitivity/resistance), albumin (microalbuminuria?)Note: Renal insufficiency without microalbuminuria or macroalbuminuria is usually ischemic (hypertensive nephropathy/kidney disease due to hypertension).
- Electrolytes – calcium* , potassium and phosphate* .
- Renal parameters – urea, creatinine, creatinine clearance (calculation or measurement) [decrease in GFR/decrease in glomerular filtration rate]Note: Check eGFR (estimated GFR; estimated glomerular filtration rate/measure of renal function) every 3/6/12 months and adjust dose of antidiabetic drugs if necessary, and concomitant medication if necessary.
- Uric acid – high-normal serum uric acid levels appear to be an early warning sign of diabetic renal impairment. They appear to indicate renal loss of function in type 1 diabetics at a time when albuminuria is not yet present!
- Total cholesterol (LDL-/HDL-cholesterol), triglycerides.
- Parathyroid hormone* – hormone that increases blood calcium levels.
Bold: control parameters that should be checked at least twice a year.* Additional laboratory parameters from CKD stage 3 (creatinine clearance < 60 ml/min/1.73 m 2).
In urine testing, attention is paid primarily to the presence of protein (albumin) or albumin (due to kidney damage).
A distinction is made between
- Microalbuminuria – in this case, between 20-200 mg / l albumin (a special protein) is present in the urine.
- Macroalbuminuria – this is more than 200 mg / l albumin in the urine.
Since the albumin value can also be temporarily increased, for example, during physical exertion or febrile illness, a conspicuous value should always be checked.
Laboratory parameters 2nd order – depending on the results of the history, physical examination, etc. – for differential diagnostic clarification.
- N-acetylglucosaminidase (β-NAG) – increased excretion in tubular renal damage (diabetic nephropathy, hypertension).
Screening of diabetic nephropathy (DN)
Screening for DN in all people with type 2 diabetes and in all type 1 diabetic patients from 5 years after diagnosis consists of:
- Serum creatinine-based GFR (eGFR) estimation by CKD-EPI formula (CKD-EPI: “Chronic Kidney Disease Epidemiology Collaboration”)/cystatin C would be better.
- Urinary albumin excretion (Note: microalbuminuria is not specific for diabetic nephropathy and also shows high variability).
- Urine proteomic analysis by capillary electrophoresis and mass spectrometry (CE-MS) – CKD273 maps insb. fibrosis (e.g., via collagens) and inflammation (e.g., via α-1-antitrypsin); this urine proteome classifier is already used for early detection of “chronic kidney disease” (CKD).
