Abstract
Since the 1930s when Kimmelstiel and Wilson first described the classic nodular glomerulosclerosis lesions in diabetic kidneys, nephropathy has been recognized as a major and common complication of diabetes. Nearly 40% of diabetics around the world have microalbuminuria, a marker of progression to chronic kidney disease (CKD). Diabetic kidney disease (DKD) is also considered a leading cause of CKD worldwide. Given the significant morbidity, mortality, and health-care burden, several clinical and scientific societies continue to seek a better understanding of this disease. Screening for microalbuminuria and controlling hyperglycemia remain the pillars for the prevention of diabetic nephropathy. However, evidence from multiple studies suggests that controlling DKD is more challenging. Some studies suggest that there is variability in the incidence of renal complications among patients despite comparable hyperglycemic control. Therefore, there has been great interest in studying the inherent, renal protective role of the different antihyperglycemic agents. This review will shed light on the pathophysiology, screening, and diagnosis of DKD. It will also discuss the treatment and prevention of diabetic nephropathy, with a specific focus on comparing the mechanisms, safety profiles, and efficacy of the different antihyperglycemic medications.
Highlights
Diabetes and chronic kidney disease (CKD) are worldwide public health problems that affect millions of people
There was no significant improvement in retinopathy or macrovascular outcomes; intensive control was associated with 21% relative risk reduction in new or worsening nephropathy [40]
Despite the continuous interest in finding newer antihypertensive medications that could slow the progression of diabetic kidney disease (DKD), angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) remain the most important tools in our arsenal at this time in controlling blood pressure and albuminuria in diabetic nephropathy
Summary
Diabetes and chronic kidney disease (CKD) are worldwide public health problems that affect millions of people. There was no significant improvement in retinopathy or macrovascular outcomes; intensive control was associated with 21% relative risk reduction in new or worsening nephropathy (defined as macroalbuminuria, doubling of creatinine, the need for renal replacement therapy, or death secondary to renal disease) [40].
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