DIABETIC NEPHROPATHY: LATEST GUIDELINES AND MANAGEMENT STRATEGIES

Abstrak

In 2015, the International Diabetic Federation estimated that the prevalence of diabetes was 8.8% from ages 20 to 79 years affecting a population of approximately 440 million people. This is predicted to grow to over 550 million people by the year 2035 [i]. One of the most important clinical features of diabetes is its association with chronic tissue complications. A short-term increase in hyperglycemia does not result in serious clinical complications. The duration and severity of hyperglycemia is the major causative factor in initiating organ damage. Early morphological signs of renal damage include nephromegaly and a modified Doppler, but the degree of damage is best ascertained from proteinuria and Glomerular filtration rate (GFR). The average incidence of diabetic nephropathy is high (3% per year) during the first 10 to 20 years after diabetes onset. Typically, it takes 15 years for small blood vessels in organs like kidney, eyes and nerves to get affected. It is estimated that more than 20 and up to 40% of diabetic patients will develop chronic kidney disease (CKD), depending upon the population, with a significant number that develop end stage kidney disease (ESKD) requiring renal replacement therapies such as kidney transplantation. Incidentally, diabetes with no clinical sign of kidney damage during the initial 20 to 25 years is significantly less likely (1% a year) to cause major renal complication later in life.

[i] Andersen AR, Christiansen JS, Andersen JK, Kreiner S, Deckert T. Diabetic nephropathy in type 1 (insulin-dependent) diabetes: an epidemiological study. Diabetologia. 1983;25:496–501.