An Insight about Diabetic Nephropathy Diagnosis and Management

Abstract

Background: Diabetic nephropathy is a progressive kidney disease caused by angiopathy of capillaries in the kidney glomeruli. It is characterized by nephrotic syndrome and diffuse glomerulosclerosis. It is due to longstanding diabetes mellitus.Diabetic Nephropathy is the leading cause of chronic kidney disease in patients starting renal replacement therapy and is associated with increased cardiovascular mortality. Clinically, DN has been characterized by a progressive increase in albumin excretion ratio (AER), a decline in GFR, and an increase in BP.  With the increasing use of RAAS blocker in diabetic patients, DN with normoalbuminuria or low microalbuminuria but declining eGFR has been described. Renal involvement is diagnosed to be secondary to diabetes in the setting of long-standing diabetes with diabetic neuropathy or diabetic retinopathy particularly in type I diabetics, where there is a good correlation. Renal manifestations in diabetes are classified into five stages including glomerular hyperfiltration, normoalbuminuria, microalbuminuria, macroalbuminuria, and finally ESRD. The goals of treatment are to slow the progression of kidney damage and control related complications. In normo- or microalbuminuric subjects, the aim of treatment is to intervene at arterial hypertension, hyperglycemia, smoking habit and probably dyslipidemia. Even in the absence of clear data showing that the management of these risk factors individually is beneficial to DN, they are also risk factors for cardiovascular disease and should be aggressively treated.