Diabetes is the leading cause of end stage renal disease across the globe. Due to the epidemic of diabetes secondary to obesity and the aging of the population, rates of kidney disease secondary to diabetes are increasing.

The early and timely detection of CKD among patients with diabetes is usually done through the measurement of urinary albumin excretion. The initial method of screening comprised of a timed urine collection confirmed on at least two of three occasions over a 6-month period. 

Persistently raised levels of urine albumin excretion≥30-299 mg/24 h or spot urine albumin-to-creatinine ratios ≥30-299 mg/g indicate the presence of microalbuminuria while urine albumin excretion levels higher than this (≥300 mg/24 h or albumin-to-creatinine ratio≥300 mg/g in a spot urine sample) show macroalbuminuria. 

Stage 1 refers to patients who have evidence of some kidney damage that stays for over 3 months in case of a normal or increased GFR. 

Stage 2 includes patients with evidence of kidney damage and a GFR between 60 and 89 ml/min/1.73 m². 

Stages 3-5 are based on GFR exclusively, and these patients may not necessarily have an evidence of kidney damage like microalbuminuria. Stage 5 depicts kidney failure (GFR<15 ml/min/1.73 m²) and includes patients requiring renal replacement therapy. 

The treatment for stage 1-3 includes the treatment of comorbid conditions and interventions for regression of CKD progression. Renal replacement therapy should be initiated during stage 4. Stage 5 indicates the need for renal replacement therapy once uraemia arises. 

Reference: Kramer H, Molitch ME. Screening for kidney disease in adults with diabetes. Diabetes Care. 2005; 28: 1813-1816.