Atypical presentations of diabetic nephropathy and novel therapies

Abstract

Diabetes mellitus is a leading cause of end stage renal failure and contributes to a diffuse arteriolopathy. Diabetic nephropathy (DN) has been typically characterized by progressive proteinuria associated with progressive renal insufficiency. However this typical pattern of DN and proteinuria may be inadequate for a complete definition of DN. While glucotoxicity has been classically considered to be the agent of renal injury, other "atypical" mediators of renal injury also contribute. In addition, the renal pathologic changes can also be atypical for a sizable population of diabetics. The dissociation of albuminuria from declining glomerular filtration rate and even from the renal pathologic changes suggests alternative mechanisms are responsible for renal injury. Diabetes could be considered a chronic inflammatory disease with nephropathy resulting from the interplay of inflammatory mediators and the immune system. There are other unusual or "atypical" associations of the kidney and diabetes, which will be discussed in this chapter.