الفهرس 
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Abstract
The general objective of the present study was to reduce chronic kidney disease progression as a complication of type 2 diabetes mellitus to prevent end stage renal failure . This was achieved through determination of the prevalence of renal disease progression (diabetic nephropathy) in type 2 diabetic patients and study its risk factors among studied group and test the effect of interventional program consists of life style modification, tight glycemic control and recommended dose of ACE inhiptors in delaying the progression of diabetic nephropathy among type 2 diabetic patients.
Finally we need to assess the Knowledge, Attitude and Practice (KAP)of family physicians about chronic kidney disease (CKD) and how to deal with them .
The study was conducted in a rural area which was represented by Monshaat Soultan village, in the family health center of the university and family health unit in the village. All diabetic patients attending to selected family health centre and family health unite for routine follow up of type 2 diabetes mellitus . Diagnosis of diabetic nephropathy were done through detection of microalbumin in urine which was
diagnosed at 17- 174 mg/l . subjects with microalbuminurea were subjected to well constructed program consisted of receiving one of ACEI ( Capoten 75 mg/day, divided doses) even in normotensive patients , life style modification weight reduction, tight glycemic control and control blood pressure.
The present study shows the prevalence of microalbuminuria at 43.4% of the studied group .There were significant relation between microalbuminurea and age of the patient duration of diabetes, presence of hypertension and dyslipdemia .
After follow up one year for evaluation of the intervention program, the mean of microalbuminurea was significantly reduced from 81.08±70.5 to 75.7±82.04. Mean of the body mass index of the studied group significantly declined from 30.89±5.32 to 29.67±5.05 and mean of the HgA1c of the studied group declined significantly from 7.99±0.78 to 7.43±0.70 after intervention program . The were also a significant decline of mean of the blood pressure from 1.09±9.71 to 1.01±5.94.
This study also helps to highlights areas where we need to work on to improve outcomes for CKD patients through studing knowledge aatidude and practice of family physician in dealing with CKD . The results of this study represented a gap in knowledge , attitude and practice among physicians regarding management of CKD. Some of the participants recognized that eGFR measurement helped them in early identification of the disease, severity of CKD and were aware of the implications of late referral to nephrologists, despite of this knowledge they did not refer early. Majority of physicians still rely on the serum creatinine as a marker of severity and refer based on this test. The worrying finding was that some would refer very late based on creatinine as shown in our study.
The knowledge, attitude and practices of physicians can be improved by arranging local and regional workshops, use of aids like posters and leaflets displayed in hospitals to highlight the issues related to
management of.