Chapter 22: Diabetic Nephropathy
Urine Nephrology Now: A Primer for Students in Nephrology
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Chapter 22: Diabetic Nephropathy
Understanding Diabetic Nephropathy as a Progressive Disease
Diabetic nephropathy is the leading cause of CKD and ESRD, affecting nearly 40% of patients with diabetes. It progresses through predictable stages.
Stage 1: Hyperfiltration
GFR increases 20-40% above normal. Kidneys enlarge. Clinically silent.
Stage 2: Silent Phase
GFR normalizes, but structural changes like basement membrane thickening begin.
Stage 3: Microalbuminuria
First clinical sign (albumin 30-300 mg/day). Represents the last potentially reversible stage.
Stage 4: Overt Proteinuria
Protein >300 mg/day. GFR begins to decline steadily.
Stage 5: End-Stage Renal Disease
GFR <15 mL/min/1.73m², requiring RRT.
Comprehensive Management Approach
Management involves a multi-pronged approach:
- Glucose Control: Target HbA1c <7%.
- Blood Pressure Control: Target <130/80 mmHg.
- RAAS Inhibition: First-line therapy with ACE inhibitors or ARBs.
- SGLT2 Inhibitors: Now a cornerstone of therapy for both kidney and cardiovascular protection.
- GLP-1 Agonists & Finerenone: Emerging protective therapies.