Diabetic nephropathy

Abstract

Diabetic kidney disease (DKD) affects around 1 in 3 patients with type 1 or type 2 diabetes and is more prevalent in non-Caucasians. Diagnosis and staging of DKD uses two dimensions: albumin excretion rate (AER Stages 1-3 (normo-, micro-, macroalbuminuria)) and glomerular filtration rate (GFR (ml/min/1.73m2) Stage 1, >90; Stage 2, 90-60; Stage 3, 59-30; Stage 4, 29-15; and Stage 5, <15). Although increases in AER usually precede decreases in GFR, early GFR decline occurs independently of AER in about 1 in 4 subjects. Intervention trials have shown that glycemic control (HbA1c ˜ 7.0%, 53 mmol/mol) can reduce onset of DKD, while in later stages of DKD blood pressure control based on RAS inhibi..