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Diagnosis and management of diabetic kidney disease – part 1



This first of two articles seeks to explain the nature, classification and clinical implications of diabetic kidney disease. The importance of screening and monitoring is discussed. Practical information on avoidance of acute kidney injury and criteria for referral of diabetic kidney disease are covered

Diabetic kidney disease (DKD) represents chronic kidney disease (CKD) attributable to the adverse effects of diabetes on the kidney. Diabetic nephropathy specifically refers to the pathology within renal glomeruli arising from hyperglycaemia. Alongside retinopathy and neuropathy, nephropathy constitutes a microvascular complication of diabetes.1 (For Part 2, click here)

In diabetic nephropathy elevated glucose levels lead to glycation of molecules in the basement membrane of the glomerular capillaries. The glomerular basement membrane becomes thickened but leaks proteins into the urine, initially small molecules like albumin but subsequently larger protein molecules. The effective filtration area of the glomeruli is reduced leading to a rise in creatinine levels and reduced estimated glomerular filtration rate (eGFR).2

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