Nonalbuminuric diabetic kidney disease: what is known? Literature review

Abstract

Urinal albumin excretion is widely used in clinical practice as an indicator of diabetic renal injury. In accordance with a classical conception of diabetic nephropathy clinical course, an albuminuria usually precedes a reduction of renal function.
 The review is devoted to discussion of an actual problem of contemporary nephrology, nonalbuminuric diabetic kidney disease (NADKD), its prevalence increasingly grows in population of patients with type 2 diabetes mellitus due to efficacy of glucose lowering, hypotensive, hypolipidemic therapy and smoking cessation. NADKD is more frequently revealed among females; it is associated with arterial hypertension and ischemic heart disease. Renal changes in patients with NADKD are heterogenous compared with albuminuric diabetic patients and interstitial changes as well as atherosclerosis can turn out to be the main morphological finding in the absence of glomerulopathy signs. Some modern pathophysiological mechanisms proposed today for understanding of NADKD such as vascular, inflammatory, acute renal injury and use of pharmacological agents with renoprotective properties are elucidated. Contemporary data about clinical characteristics of NADKD, as well as its prognostic value, diagnostics and monitoring and its association with cardiovascular risk are given. A prognostic significance of NADKD should be defined more precisely. NADKD is shown to increase a risk of myocardial infarction and stroke development as well as a death from cardiovascular causes in patients with diabetes mellitus. An importance of the search for alternative diagnostic markers for detecting renal injury in the absence of albuminuria is emphasized. The evaluations of the markers of tubular damage and interstitial fibrosis, as well as proteomic approaches, are considered today as perspective diagnostic and prognostic options in NADKD. The study of pathogenesis, pathomorphology, clinical course of NADKD, as well as the development of approaches for an early diagnostics and treatment of this complication of diabetes mellitus are determined as the tasks for future research.