Diabetic Kidney Disease

Diabetic kidney disease (DKD) is a major microvascular complication of diabetes that develops in one third of patients with type 1 diabetes and up to half of patients with type 2 diabetes. Although rates of other diabetes complications have declined in recent years, the number of cases of DKD advancing to kidney failure and death is rising. DKD is clinically characterized by persistent albuminuria and/or a sustained reduction in glomerular filtration rate that is associated with a variety of structural changes within the kidney. The pathophysiology of DKD is complex and involves metabolic, hemodynamic, inflammatory, fibrotic, and epigenetic alterations. The prevention and treatment of DKD are centered around a multifactorial approach to address modifiable DKD risk factors. Interventions include optimization of glycemic control, use of glucose-lowering agents that provide kidney protection, blood pressure control and use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, cardiovascular risk reduction, and healthful dietary strategies.