Kidney disease in diabetes: from mechanisms to clinical presentation and treatment strategies
CA Ricciardi, L Gnudi - Metabolism, 2021 - Elsevier
CA Ricciardi, L Gnudi
Metabolism, 2021•ElsevierMetabolic and haemodynamic perturbations and their interaction drive the development of
diabetic kidney disease (DKD) and its progression towards end stage renal disease (ESRD).
Increased mitochondrial oxidative stress has been proposed as the central mechanism in
the pathophysiology of DKD, but other mechanisms have been implicated. In parallel to
increased oxidative stress, inflammation, cell apoptosis and tissue fibrosis drive the
relentless progressive loss of kidney function affecting both the glomerular filtration barrier …
diabetic kidney disease (DKD) and its progression towards end stage renal disease (ESRD).
Increased mitochondrial oxidative stress has been proposed as the central mechanism in
the pathophysiology of DKD, but other mechanisms have been implicated. In parallel to
increased oxidative stress, inflammation, cell apoptosis and tissue fibrosis drive the
relentless progressive loss of kidney function affecting both the glomerular filtration barrier …
Abstract
Metabolic and haemodynamic perturbations and their interaction drive the development of diabetic kidney disease (DKD) and its progression towards end stage renal disease (ESRD).
Increased mitochondrial oxidative stress has been proposed as the central mechanism in the pathophysiology of DKD, but other mechanisms have been implicated.
In parallel to increased oxidative stress, inflammation, cell apoptosis and tissue fibrosis drive the relentless progressive loss of kidney function affecting both the glomerular filtration barrier and the renal tubulointerstitium.
Alteration of glomerular capillary autoregulation is at the basis of glomerular hypertension, an important pathogenetic mechanism for DKD.
Clinical presentation of DKD can vary. Its classical presentation, often seen in patients with type 1 diabetes (T1DM), features hyperfiltration and albuminuria followed by progressive fall in renal function. Patients can often also present with atypical features characterised by progressive reduction in renal function without albuminuria, others in conjunction with non-diabetes related pathologies making the diagnosis, at times, challenging.
Metabolic, lipid and blood pressure control with lifestyle interventions are crucial in reducing the progressive renal function decline seen in DKD.
The prevention and management of DKD (and parallel cardiovascular disease) is a huge global challenge and therapies that target haemodynamic perturbations, such as inhibitors of the renin-angiotensin-aldosterone system (RAAS) and SGLT2 inhibitors, have been most successful.
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