Abstract
The prevalence of diabetes continues to rise worldwide. In addition to rising rates of diabetic kidney disease, we are also seeing a parallel rise in nondiabetic kidney disease among patients with diabetes. These nondiabetic lesions include focal segmental glomerulosclerosis, IgA nephropathy, membranous nephropathy, and other glomerular diseases. The management of diabetic kidney disease is rapidly evolving to include, beyond glycemic control and renin angiotensin inhibition, the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors and mineralocorticoid receptor antagonists. These and other new treatment strategies should be applicable to managing glomerular disease in diabetic patients to reduce toxicities associated with immunosuppression and, in particular, corticosteroids. The prevalence of glomerular disease in diabetic patients is underappreciated. Diagnosis and appropriately treating these diseases remain an important avenue to modify kidney outcomes in diabetic patients.
Highlights
Diabetic kidney disease (DKD) is the leading cause of disability-adjusted life years (DALYs) in chronic kidney disease (CKD), accounting for 30.7% of the total CKD DALYs [1]
The prevalence of diabetes mellitus (DM) among United States adults is 12.2% of the general population, and CKD is frequent in DM, with 36% of diabetic adults manifesting some degree of CKD [2]
Diabetic glomerulosclerosis is a diagnosis that refers to specific pathologic structural changes and functional changes seen in the kidney biopsies of patients with DM that results from the direct effects of DM on the kidneys [4]
Summary
Diabetic kidney disease (DKD) is the leading cause of disability-adjusted life years (DALYs) in chronic kidney disease (CKD), accounting for 30.7% of the total CKD DALYs [1]. Two large-scale, retrospective examinations of kidney biopsies of patients who had been diagnosed with diabetes revealed that the majority of patients (63–72.5%) had NDKD lesions either alone or alongside diabetic glomerulosclerosis [6,7]. In these two studies, focal segmental glomerulosclerosis (FSGS) was the most common finding in the NDKD alone group (just over 20%), followed by hypertensive nephrosclerosis, acute tubular necrosis, IgA nephropathy (IgAN), and membranous nephropathy (MN). It denotes an underlying tendency to biopsy older patients or to look for NDKD among diabetic patients [16]
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