To diagnose diabetic nephropathy, earliest sensitive test is: March 2010, March 2013

Ans. C: Microalbuminuria Protein urine test/Urine protein/Urine albumin and Albuminuria-measures the amount of proteins commonly albumin, found in a urine sample. This test is most often performed as a screening test for kidney disease. Normally, protein is not appears in urine when a routine dipstick test is performed. Normal values for a random urine sample are approximately 0 to 8 mg/ dL. If higher may be due to diabetic nephropathy. Microalbuminuria test measures for small quantities of protein commonly albumin in the urine sample. The amount of water in urine can vary and affect the concentration of albumin. Thus amount of creatinine is also measured and the result is repoed as the ratio of albumin to creatinine. This test is earliest sensitive test to diagnose diabetic nephropathy as albuminuria is the earliest manifestation of diabetic nephropathy. Abnormal levels of the protein (mostly albumin) in the urine signal the beginning of a condition called microalbuminuria, often noted in diabetic nephropathy. 30 to 300 mgs of albumin in 2 different 24 hour urine samples is diagnosed as microalbuminuria. More than 300 mgs of albumin is diagnosed as albuminuria. BUN (Blood urea nitrogen), Urea nitrogen is formed when protein are breaks down. The normal value will be in the range of 7 - 20 mg/ dl. Higher than normal level may be an indication for kidney disease. Serum creatinine test measures creatinine level in blood. Creatinine is a breakdown product of creatine, an impoant pa of muscle. This test is done to examine kidney function. If kidney function is abnormal, blood has increased level of creatinine, due to decreased excretion of creatinine in the urine. Creatinine levels will vary depends on the person's size and muscle mass. Glomerular Filtration Rate (GFR), which is the best way to find how well the kidney functions. GFR can be calculated from the blood creatinine, age, race, gender and other factors. GFR value is helpful to determine the stage of kidney disease and helps to plan fuher treatment. Ultrasound or CT scan is helpful to find any physical structural abnormalities, that is the kidney is larger or smaller than normal. Kidney biopsy