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Diabetes and Chronic Kidney Disease

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Management of Chronic Kidney Disease

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Abstract

The burden of diabetes continues to increase worldwide with diabetic nephropathy (DN) leading in the causes for chronic kidney disease (CKD) in the developed world. DN may occur in both type 1 and type 2 as well as in other secondary forms of diabetes mellitus (DM) with similar lifetime risks of developing nephropathy. Increased urinary albumin excretion hallmarks the clinical manifestation of diabetic kidney disease with associated significant risk for developing overt DN. Microvascular disease including retinopathy and neuropathy is frequently present in those with type 1 DM. Approximately 2/3 of patients with type 2 DM also have evidence for these microvascular changes. Renal biopsy findings of mesangial expansion, basement membrane thickening, and glomerulosclerosis are typical for DN. Hyperglycemia induces oxidative stress, reactive oxygen species, and fibrosis with activation of renin-angiotensin-aldosterone system (RAAS) and transforming growth factor-β (TGF-β) as well as formation of Amadori glycation end products. These biologic processes appear to play important roles in podocyte injury, apoptosis, and extracellular matrix protein deposition with subsequent albumin leak. Clinical factors such as genetic predisposition, high blood pressure and lipids, obesity, and smoking increase the rate of progression of DN. Thus, identifying patients predisposed to the development of diabetes or early recognition of those with diabetes is important in considering early intervention to prevent microvascular complications. Optimizing blood glucose and blood pressure, use of RAAS blockers, control of serum lipids, weight control, and smoking cessation are important interventions in slowing progression of diabetic kidney disease. Optimal treatment for DM continues to evolve with new therapies including inhibitors of TGF-β and agonists of peroxisome proliferator-activated receptors gamma (PPARγ) being investigated to decrease progression of DN.

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Authors and Affiliations

  1. Department of Internal Medicine, University of Connecticut School of Medicine/John Dempsey Hospital, Internal Medicine/Calhoun Cardiology Center, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT, 06030, USA

    Meryem Tuncel Kara MD

  2. Division of Renal Diseases and Hypertension/Department of Internal Medicine, University of Colorado Denver AMC, 12700 East 19th Avenue, Research 2, Room 7002, C281, Aurora, CO, 80045, USA

    Moshe Levi MD

  3. Department of Medicine, University of Virginia, Salem VA Medical Center, 1970 Roanoke Blvd., Salem, VA, 24153, USA

    Devasmita Choudhury MD

Authors
  1. Meryem Tuncel Kara MD
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  2. Moshe Levi MD
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  3. Devasmita Choudhury MD
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Corresponding author

Correspondence to Devasmita Choudhury MD .

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Editors and Affiliations

  1. Department of Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey

    Mustafa Arici

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© 2014 Springer-Verlag Berlin Heidelberg

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Kara, M.T., Levi, M., Choudhury, D. (2014). Diabetes and Chronic Kidney Disease. In: Arici, M. (eds) Management of Chronic Kidney Disease. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54637-2_4

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  • DOI: https://doi.org/10.1007/978-3-642-54637-2_4

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-54636-5

  • Online ISBN: 978-3-642-54637-2

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