Diabetic Nephropathy

History:
 Body Swelling and frothy Urine
 Urinary and Uremic features, Systemic Inquiry
 Duration and Control of DM, Treatment with insulin/OHGA, Requirement increasing or
decreasing, Hypoglycemic episodes
 History of Complications of Diabetes:
A. Macrovascular:
1. IHD
2. CVA
3. PVD (Intermittent Claudication)
4. HTN
5. Foot Ulcers and Gangrene (both macro and microvascular)
B. Microvascular:
1. Diabetic Retinopathy (H/O of Photocoagulation)
2. Peripheral neuropathy (Glove and Stocking) and Paresthesia (Burning of feet)
3. Autonomic Neuropathy:
a. Postural Dizziness
b. Delayed Gastric Emptying
c. Altered Bowel Habits
d. Decreased urinary frequency but increased amount (Cystopathy)
e. Erectile Dysfunction
 Suspected Renovascular Hypertension:
 Severe and/or Resistant Hypertension
 Dramatic Response to ACEi/ARB
 AKI/Worsening Renal Failure after ACEi/ARB
 Rule out any acute Renal Insult:
 Volume depletion (Diuretics, Vomiting, Diarrhea, Blood Loss)
 Cardiac Event
 Drugs (Hakeem Medication, NSAIDs, ACEi/ARB, Contrast)
 UTI/Other infections
 Cystopathy
 Superimposed GN
 Rest of Past and Treatment History
 Family and Personal History

Examination:
1. BP with postural drop and postural Tachycardia
2. Peripheral Vascular disease
3. Pain/Touch, Position and Vibration sensation
4. Proximal Muscle weakness, Focal Deficit, Signs of Old CVA
5. Fundoscopy
6. Palpable bladder
7. Renal and Carotid Bruit
8. Diabetic Foot
9. Dermopathy
10. Upper Limbs for AVF or Vascular adequacy for Access construction