Description
Diabetes is a leading cause of chronic kidney disease (CKD), and while proteinuria is a common marker, the relationship between diabetes and kidney dysfunction goes beyond this indicator. Diabetic nephropathy involves a complex pathophysiology, including glomerular hyperfiltration, endothelial dysfunction, and tubulointerstitial fibrosis, which contribute to kidney damage. Early-stage diabetic kidney disease can present with subtle signs like elevated blood pressure or changes in glomerular filtration rate (GFR), making proteinuria an insufficient marker for early detection. Effective management of blood glucose, blood pressure, and lipid levels is crucial in slowing the progression of kidney disease in diabetic patients.
Summary Listen
- Diabetes mellitus is a genetically heterogeneous metabolic disease characterized by elevated blood glucose levels and disregulation of carbohydrate, protein, and lipid metabolism. Diagnosis involves A1C levels ≥ 6.5%, fasting plasma glucose ≥ 126 mg/dL, 2-hour glucose plasma glucose ≥ 200 mg/dL during oral glucose tolerance test, or random plasma glucose ≥ 200 mg/dL in individuals with classic symptoms.
- Diabetic kidney disease (DKD) is kidney disease specific to diabetes and is diagnosed based on estimated glomerular filtration rate (eGFR) and albuminuria. It is crucial to differentiate DKD from diabetic nephropathy, a more specific disease directly related to diabetes.
- The pathogenesis of DKD involves hemodynamic instability, metabolic factors, inflammation, and fibrosis. These factors lead to tubulointerstitial damage, glomerulosclerosis, and mesangial expansion, ultimately resulting in kidney fibrosis and CKD progression. Proteinuria is a key marker, with glomerular proteinuria predominantly characterized by albuminuria.
- Preventive measures for diabetes and DKD include controlling blood pressure and sugar levels, staying hydrated, and limiting painkiller use. Managing blood pressure, maintaining adequate hydration, and regular monitoring are essential.
- Management of DKD includes dietary adjustments, medications like SGLT2 inhibitors and GLP-1 receptor agonists, dialysis for advanced cases, and kidney transplantation. Adherence to guidelines from ADA and KDIGO is crucial, emphasizing comprehensive, team-based care.
- Future directions include exploring genetic factors, regenerative medicine approaches, and the potential of AI in diagnosing, managing, and preventing DKD. Early referral to a nephrologist is vital in patients with proteinuria, difficult-to-control hypertension, unusual clinical findings, or rapid progression.
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About the Speakers
Dr. Amitabh Kulkarni
Head of Department, Nephrology, NMC Speciality Hospital, Dubai
Financial Disclosure
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