REVIEWRationale and Strategies for Early Detection and Management of Diabetic Kidney Disease
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
REFERENCES (75)
- et al.
Early detection and treatment of renal disease in hospitalized diabetic and hypertensive patients: important differences between practice and published guidelines
Am J Kidney Dis
(1997) - et al.
Kidney disease as a risk factor for recurrent cardiovascular disease and mortality
Am J Kidney Dis
(2004) - et al.
Development and progression of nephropathy in type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS 64)
Kidney Int
(2003) - et al.
Proteinuria in diabetic kidney disease: a mechanistic viewpoint
Kidney Int
(2008 Jul) - et al.
The normal kidney filters nephrotic levels of albumin retrieved by proximal tubule cells: retrieval is disrupted in nephrotic states
Kidney Int
(2007 Mar) - et al.
The physiological and pathophysiological roles of the GH/IGF-axis in the kidney: lessons from experimental rodent models
Growth Horm IGF Res
(2004) - et al.
Effect of two years of strict metabolic control on progression of incipient nephropathy in insulin-dependent diabetes
Lancet
(1986) - et al.
Utility of radioisotopic filtration markers in chronic renal insufficiency: simultaneous comparison of 125I-iothalamate, 169Yb-DTPA, 99mTc-DTPA, and inulin: the Modification of Diet in Renal Disease Study
Am J Kidney Dis
(1990) - et al.
Performance of the Cockcroft-Gault and Modification of Diet in Renal Disease equations in estimating GFR in ill hospitalized patients
Am J Kidney Dis
(2005) - et al.
Cystatin C is a more sensitive marker than creatinine for the estimation of GFR in type 2 diabetic patients
Kidney Int
(2002)