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Diabetic Kidney Disease: Identification, Prevention, and Treatment

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Precision Medicine in Diabetes

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Abstract

Diabetes is the most common cause of end-stage kidney disease (ESKD) in the USA and other developed countries. About 50% of the patients with type 1 diabetes (T1D) and 30% of those with type 2 diabetes (T2D) develop chronic kidney disease (CKD) (Afkarian, et al., J Am Soc Nephrol. 24:302–8, 2013; Fox, et al., Lancet. 380:1662–73, 2012). Diabetic nephropathy is a chronic condition that develops over many years, and it is characterized by a gradual increase in urinary albumin excretion, blood pressure levels and cardiovascular risk, declining glomerular filtration rate (GFR), and eventual ESKD. Annual screening for CKD should include both albuminuria measurements and estimates of GFR. Diabetic nephropathy manifests as a constellation of kidney structural changes considered unique to this disease, which closely correlate with kidney function. Multiple factors are associated with CKD in diabetes, and patients with diabetes often require multiple therapies aimed at prevention of progressive CKD and its associated comorbidities and mortality. Management of cardiorenal risk factors, including lifestyle modifications (diet, exercise, and cessation of smoking); glucose, blood pressure, and lipid control; use of agents blocking the renin-angiotensin-aldosterone system; and use of SGLT2 inhibitors in patients with T2D and other agents with proven renal or cardiovascular benefit are the cornerstones of therapy.

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Abbreviations

ACR:

Albumin-to-creatinine ratio

CKD:

Chronic kidney disease

CVD:

Cardiovascular disease

DKD:

Diabetic kidney disease

ESKD:

End-stage kidney disease

eGFR:

Estimated glomerular filtration rate

GBM:

Glomerular basement membrane

GFR:

Glomerular filtration rate

KDIGO:

Kidney Disease: Improving Global Outcomes

RAS:

Renin-angiotensin system

T1D:

Type 1 diabetes

T2D:

Type 2 diabetes

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Authors and Affiliations

  1. Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Division of Pediatric Nephrology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA

    M. Luiza Caramori

  2. Steno Diabetes Center Copenhagen, Herlev, Denmark

    Peter Rossing

  3. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

    Peter Rossing

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  1. Division of Endocrinology, University of Virginia, Charlottesville, VA, USA

    Rita Basu

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Caramori, M.L., Rossing, P. (2022). Diabetic Kidney Disease: Identification, Prevention, and Treatment. In: Basu, R. (eds) Precision Medicine in Diabetes. Springer, Cham. https://doi.org/10.1007/978-3-030-98927-9_7

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