Diabetic Kidney Disease
Diabetic kidney disease is common, affecting 20-40% of people with diabetes.
It is characterised by increased urine albumin excretion (micro or macroalbuminuria) and/or reduced kidney function in the absence of other causes for kidney disease. Hyperglycaemia, hypertension, a genetic predisposition, smoking and dyslipidaemia are major risk factors for diabetic kidney disease.
Diabetic kidney disease is the leading cause of End-stage Kidney Disease (ESKD) requiring renal replacement therapy.
Patients with diabetic kidney disease have a markedly increased risk of cardiovascular events and mortality.
Therefore, early detection of diabetic kidney disease is crucial. Annual screening tests for urine albumin excretion and kidney function are recommended.
Micro- and macro-albuminuria are risk factors for cardiovascular events, kidney failure and death in people with diabetes. Reduced kidney function (glomerular filtration rate) is also a separate and independent risk factor for cardiovascular events, kidney failure and death, and the additional risk is additive to that associated with increased urine albumin excretion. Coexisting hypertension accelerates the development of renal failure.
Multifactorial approaches including optimisation of blood glucose and blood pressure control, management of risk factors, and lifestyle modification can slow progression of the kidney disease.
Reno-protective agents targeting renin-angiotensin-aldosterone system are the first line therapy for reduction of microalbuminuria and blood pressure control. Glucose lowering therapy should be tailored for individuals with diabetic kidney disease. Dose adjustment is required for most agents.
Timely referral of patients with diabetic kidney disease to a nephrologist is important for those with advanced or deteriorating diabetic kidney disease.