Endocrinol Metab.  2016 Jun;31(2):245-253. 10.3803/EnM.2016.31.2.245.

Current Challenges in Diabetic Nephropathy: Early Diagnosis and Ways to Improve Outcomes

Affiliations
  • 1Department of Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea. injkim@pusan.ac.kr

Abstract

Diabetes is often associated with chronic kidney disease (CKD) and is the primary cause of kidney failure in half of patients who receive dialysis therapy. Given the increasing prevalence of diabetes and its high morbidity and mortality, diabetic nephropathy is a serious drawback in individual patients and a tremendous socioeconomic burden on society. Despite growing concern for the management of diabetic nephropathy, the prevalence of CKD with diabetes is the same today as it was 20 years ago. The current strategy to manage diabetic nephropathy, including the control of hyperglycemia, dyslipidemia, and blood pressure and the wide-spread use of renin-angiotensin-aldosterone system inhibitors, is well established to be beneficial in the early stages of diabetic nephropathy. However, the effects are uncertain in patients with relatively progressed CKD. Therefore, early diagnosis or risk verification is extremely important in order to reduce the individual and socioeconomic burdens associated with diabetic nephropathy by providing appropriate management to prevent the development and progression of this condition. This review focuses on recent research and guidelines regarding risk assessment, advances in medical treatment, and challenges of and future treatments for diabetic nephropathy.

Keyword

Albuminuria; Renal insufficiency, chronic; Diabetic nephropathies; Early diagnosis; Glomerular filtration rate

MeSH Terms

Albuminuria
Blood Pressure
Diabetic Nephropathies*
Dialysis
Dyslipidemias
Early Diagnosis*
Glomerular Filtration Rate
Humans
Hyperglycemia
Mortality
Prevalence
Renal Insufficiency
Renal Insufficiency, Chronic
Renin-Angiotensin System
Risk Assessment

Figure

  • Fig. 1 Albuminuria and glomerular filtration rate (GFR) categories for risk assessment of chronic kidney disease (CKD). The albuminuria and GFR grid reflects the risk of progression in terms of the intensity of the coloring (green, yellow, orange, red, and deep red). The numbers in the boxes are the frequency of monitoring (number of times per year). Green indicates stable disease, with follow-up measurements annually if CKD is present; yellow requires caution and measurements at least once per year; orange requires measurements twice per year; red requires measurements three times per year; and deep red requires the closest monitoring, approximately four or more times per year (at least every 1 to 3 months). Adapted from KDIGO [7], with permission from Elsevier.

  • Fig. 2 Early biomarkers of diabetic kidney disease along the kidney injury continuum. GFR, glomerular filtration rate. aAlbuminuria category A2, moderately increased albuminuria.

  • Fig. 3 Non-albumin proteinuria as a diagnostic tool for diabetic nephropathy. IgG, immunoglobulin G.


Cited by  1 articles

Renal Protection of Mineralocorticoid Receptor Antagonist, Finerenone, in Diabetic Kidney Disease
Dong-Lim Kim, Seung-Eun Lee, Nan Hee Kim
Endocrinol Metab. 2023;38(1):43-55.    doi: 10.3803/EnM.2022.1629.


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