Diabetic nephropathy overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Ali Poyan Mehr, M.D. [2] Associate Editor(s)-in-Chief: Olufunmilola Olubukola M.D.[3]
Overview
Diabetic kidney disease (Diabetes Nephropathy) is the most common cause of chronic kidney disease, leading to end-stage renal disease (ESRD) and premature death in the United States [1] .
Diabetes Nephropathy (DN) remains a major cause of end stage renal disease seriously affecting world population [2].
Diabetic Nephropathy affects male and female Diabetics equally with higher incidence of nephropathy in African-Americans (blacks), Native Americans and people of Mexican origins than in white Americans [3]. The current diabetic nephropathy therapy includes the control of hyperglycemia, dyslipidemia, and blood pressure using multiple therapeutic drugs but most especially the use of the Renin-Angiotensin-Aldosterone System Inhibitors is well established to be beneficial in the early stages of diabetic nephropathy altering the disease course and progression. Therefore, early diagnosis and institution of prompt treatment is very important in the management of Diabetes Nephropathy. Also, the role of disease prevention becomes paramount in Diabetics and non-diabetics (highly predisposed) patients.
Diabetic nephropathy (DN) is characterized by the presence of proteinuria or decreased renal function in patients with diabetes mellitus.[4][5][6]
Early Diabetic Nephropathy
The range of proteinuria in early DN is shown below[4][5][6]:
- Males: Microalbuminuria in the range of 30-300 mg/24 hrs or a spot urinary albumin/creatinine ratio of 30-300 mg/g
- Females: Microalbuminuria in the range of 30-300 mg/24 hrs or a spot urinary albumin/creatinine ratio of 20-200 mg/g
Overt Diabetic Nephropathy
Overt DN is defined according to the presence of proteinuria or according to renal function. The following ranges in overt DN are shown below[4][5][6]:
- Proteinuria > 500 mg/24 hrs or albuminuria > 300 mg/24 hrs.
- Estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m2
Historical Perspective
Classification
Pathophysiology
Diabetic nephropathy is a serious complication in patients with long standing Type 1 or Type 2 Diabetes Mellitus. It usually occurs in about 10 to 15years following the onset of diabetes mellitus. Poor glycemic control, dyslipidemia, smoking, and environmental and genetic factors play important roles in the development of diabetic nephropathy. Microalbuminuria is a primary early marker of microvascular complication that indicates a possible progression to the advanced stage of chronic kidney disease.
Causes
Differentiating Diabetic nephropathy from other Diseases
Also called Kimmelstiel-Wilson syndrome, or Nodular diabetic glomerulosclerosis and inter-capillary glomerulonephritis;
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Chest X Ray
CT
MRI
Echocardiography or Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Surgery
Medical Therapy
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
References
- ↑ John S (2016). "Complication in diabetic nephropathy". Diabetes Metab Syndr. 10 (4): 247–249. doi:10.1016/j.dsx.2016.06.005. PMID 27389078.
- ↑ Tuttle KR, Bakris GL, Bilous RW, Chiang JL, de Boer IH, Goldstein-Fuchs J; et al. (2014). "Diabetic kidney disease: a report from an ADA Consensus Conference". Diabetes Care. 37 (10): 2864–83. doi:10.2337/dc14-1296. PMC 4170131. PMID 25249672.
- ↑ Baudy A, Batuman V (2015). "Non-diabetic renal disease in diabetic patients: How to identify? When to biopsy?". J Diabetes Complications. 29 (5): 613–4. doi:10.1016/j.jdiacomp.2015.04.015. PMID 25957005.
- ↑ 4.0 4.1 4.2 Mogensen CE, Christensen CK (1984). "Predicting diabetic nephropathy in insulin-dependent patients". N Engl J Med. 311 (2): 89–93. doi:10.1056/NEJM198407123110204. PMID 6738599.
- ↑ 5.0 5.1 5.2 Mogensen CE (1984). "Microalbuminuria predicts clinical proteinuria and early mortality in maturity-onset diabetes". N Engl J Med. 310 (6): 356–60. doi:10.1056/NEJM198402093100605. PMID 6690964.
- ↑ 6.0 6.1 6.2 Reutens AT, Atkins RC (2011). "Epidemiology of diabetic nephropathy". Contrib Nephrol. 170: 1–7. doi:10.1159/000324934. PMID 21659752.