The diagnosis of renal involvement in non-insulin-dependent diabetes mellitus.

Efforts aimed at early detection and effective treatment and prevention of renal involvement in non-insulin-dependent diabetes mellitus are needed to limit the increasing social burdens of end-stage renal disease and related complications. Microalbuminuria seems to meet all the criteria required for screening of early renal disease (incipient nephropathy) and detection of patients at increased cardiovascular risk. Histologic examination is needed to ensure diagnosis of overt diabetic nephropathy in patients with macroalbuminuric non-insulin-dependent diabetes mellitus without retinopathy. Regular screening for micro- and macroalbuminuria ensures that renal and extrarenal complications may be identified early and that preventive intervention therapy is instituted, including good metabolic control and raised blood pressure correction. Preliminary evidence suggests that this is a very cost-effective use of health-care resources.