Elsevier

Mayo Clinic Proceedings

Volume 83, Issue 12, December 2008, Pages 1373-1381
Mayo Clinic Proceedings

REVIEW
Rationale and Strategies for Early Detection and Management of Diabetic Kidney Disease

https://doi.org/10.4065/83.12.1373Get rights and content

Diabetic kidney disease (DKD) occurs in 20% to 40% of patients with diabetes mellitus and is the leading cause of chronic kidney disease and end-stage renal disease in the United States. Despite the American Diabetes Association and the National Kidney Foundation advocating annual screening of diabetic patients, DKD remains underdiagnosed in the diabetic population. Early recognition of diabetic nephropathy by health care professionals is vital for proper management. The presence of microalbuminuria is particularly important as even low levels of dipstick-negative albuminuria indicate early disease long before a diminished glomerular filtration rate and are associated with an elevated cardiovascular disease risk. Like all forms of chronic kidney disease, DKD causes a progressive decline in renal function that, despite current treatment strategies, is largely irreversible. Many patients with DKD might be expected to develop end-stage renal disease, but many more patients will likely die of a cardiovascular event before renal replacement therapy is needed. Therefore, a renewed focus on cardiovascular risk factor reduction and a timely nephrology consultation with an emphasis on patient education is essential to proper DKD management.

Section snippets

METHODS

The National Library of Medicine's PubMed database was used to conduct a review of literature published between January 1976 and June 2008. The following key terms were used in the search: diabetes, kidney disease, microalbuminuria, glomerular filtration rate, and diabetic nephropathy.

Overview of Renal Pathophysiology

The kidneys receive 25% of the cardiac output of blood. Although 20% of renal plasma flow (ie, approximately 180 L) is filtered through the glomerulus, only small amounts of protein can be detected in the urine.18 Several plasma proteins are freely filtered, whereas others are prevented from crossing the glomerular filtration barrier, based on the proteins' molecular size and charge. The existence of several restrictive pores and of a glomerular charge barrier has been proposed to explain why

CONCLUSION

Diabetic kidney disease is an extremely common complication of DM and is the leading cause of CKD and ESRD in the United States. The current review has presented and analyzed data primarily from studies of patients with type 2 DM. Obviously, one should not overinterpret these data when considering other specific groups of patients, such as those with type 1 DM or elderly persons, because not all the findings and outcomes may apply.

Early detection of DKD is important not only in slowing renal

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