Renal Disease in Diabetes

Abstract

Diabetic kidney disease (DKD) would continue to grow as an entity in the setting of the global burden of diabetes. As such, healthcare workers must diagnose and treat DKD effectively in order to prevent progression. This chapter explores DKD through its classic and now changing natural history, physiology, and histology. Essential to understanding the behavior of diabetes in the kidney are topics such as Mogensen's classification, the biochemical pathways that lead to glomerular and tubule-interstitial involvement, the effect of renin-angiotensin-aldosterone system on renal hemodynamics, the hyperfiltration mechanism, and structural changes across glomeruli that lead to albuminuria. Knowledge of the former pathways is essential for the discovery of new treatments. Non-pharmacologic and pharmacologic measures have proven effective not only in the delay of diabetic nephropathy onset but also on the reversal of albuminuria in earlier stages. Pharmacological management with RAAS blockade has proven to delay DKD progression; however, despite management, many patients still progress to ESKD. In the last decade, many novel therapies have been developed, and DKD became an exciting and growing field, with hopeful perspectives that may halt DKD progression.