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Monday, July 14, 2014

Diabetic Kidney Disease: Old and New View

A recent article by Dr Sally Marshall in ACKD reviews the natural history of CKD in diabetic patients and reviews the old and the new view of looking at Diabetic Nephropathy. Highly recommend this article for everyone to review.  Here is a short summary of the review.

Old view:

Microalbuminuria is permanent and progresses to proteinuria in most cases.
The peak incidence of DN is 16 years and few after 35 years>
Classically, the microalbumuria progresses to proteinuria and then GFR declines
Usually, this was an older individual disease.

New view:

Low levels of albuminuria( rather than microalbuminuria) is a reversible phenomenon in majority( likely representing more of a hemodynamic change, inflammatory change or endothelial injury rather than structural damage in the kidney)
Higher levels of albuminuria are more likely to progress to proteinuria.
Peak incidence of diseases now ranging from 16-30 years
Atypical forms of presentations are becoming common where GFR decline can be seen without any prior proteinuric variant.  A vigilant watch is needed to notice this “non classical” DN
Finally, young adults are being effected with this entity and CKD become more of a common disease in Type 2 DM at an earlier age.

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