Diabetic kidney disease: Pathophysiological changes and urinalysis contribution to diagnosis-a narrative review

Abstract

Objective: Identify the urinalysis parameters and its possible contribution to diabetic kidney disease (DKD) diagnosis. Background: DKD is a term used to identify the effect of diabetes mellitus (DM) in the kidneys, and DKD is the most frequent and severe chronic complication of DM. The major risk factors involved in the DKD pathogenesis are smoking, hypertension, hyperglycemia, high protein diet and renal hyperfiltration. DKD constitute the leading cause of end-stage kidney disease and occurs as a result of renal microvascular lesions causing distinct and progressive morphological changes inducing albuminuria and progressive loss of kidney function. Either albuminuria or glomerular filtration rate decline are DKD unspecific markers, then newer more specific markers for DKD are needed. In dipstick analysis, we address the parameters glucose and ketone bodies, besides the protein (albumin). Methods: Evaluate the information available in the literature (articles published on PubMed indexed journals and book chapters) related to DKD and urinalysis. Conclusions: The urine sediment is useful to differential diagnosis of DKD and non-diabetic kidney disease (NDKD), with acanthocytes identifying NDKD, when observed in DM patients. In urine, the presence of podocytes may be a useful marker of disease activity in DKD. The perspectives point to development of laboratory technologies with the possibility of urine sediment cell identification and quantification, which could contribute to DKD diagnosis.