Introduction to diabetic kidney disease

Diabetes is a leading cause of kidney disease. Typically, diabetic kidney disease (also referred to as diabetic nephropathy) develops slowly, with a progressive increase in albuminuria that is followed later by a decrease in estimated glomerular filtration rate (eGFR); however, a decline in eGFR can also be seen without albuminuria. Diabetic kidney disease can eventually lead to end-stage kidney disease. Patients with diabetes can also develop other kidney diseases unrelated to diabetes.

Key risk factors for progression of diabetic kidney disease include long duration of diabetes, suboptimal blood glucose concentrations, elevated blood pressure, suboptimal blood lipid levels, obesity and tobacco smoking. Treatment of these risk factors in the early stages of chronic kidney disease with intensive glycaemic management, optimisation of blood pressure and the use of renoprotective drugs reduces progression of kidney damage, morbidity and mortality.

In patients with diabetes, presence of chronic kidney disease markedly increases risk of cardiovascular disease, independently of risk due to diabetes.

Hyporeninaemic hypoaldosteronism occurs in some patients with diabetic kidney disease. It is characterised by mild to moderate kidney impairment and severe hyperkalaemia out of proportion to the degree of kidney failure.