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Troy A. Russell, MSN, RN, APRN, BC, CNN

Troy A. Russell, MSN, RN, APRN, BC, CNN, is a Nephrology Nurse Practitioner, The VA Medical Center, Nashville, TN. He is Chairperson, Certification Committee, and Chairperson, CNN Test Committee, for the Nephrology Nursing Certification Commission (NNCC). He is a member of the Music City Chapter of ANNA.

Proteinuria has been recognized in association with diabetes mellitus as early as the 18th century. This form of renal disease is known as diabetic nephropathy. It is now clear that diabetic nephropathy is the principal cause of end stage renal disease (ESRD) in the western world. According to reports by the United States Renal Data System (USRDS), in the past two decades there has been a continual increase in the incidence of ESRD among patients with diabetes. Many patients have diabetes that progresses to diabetic nephropathy, which is often not discovered until overt nephropathy is present. Many of the complications of diabetes could be minimized if patients received a comprehensive health maintenance program that includes vigorous cardiac risk reduction; routine eye examinations; routine foot examinations; screening and treatment for microalbuminuria; optimal hypertension management; and improved glycemic control. Hence, the key is not only prudent screening of these patients, but referral as well. Using a case study approach, this article illustrates the care of patients with diabetic nephropathy in type 1 diabetes mellitus.