Diabetic Nephropathy Questions & Answers

Updated: May 03, 2018
  • Author: Vecihi Batuman, MD, FASN; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Questions & Answers

Overview

What is diabetic nephropathy?

What conditions lead to diabetic nephropathy?

What is the association between diabetes and kidney disease?

How is diabetic nephropathy identified?

What are the benefits of early treatment of diabetic nephropathy?

What are atypical presentations of diabetic nephropathy?

What is the role of glomeruli in the pathogenesis of diabetic nephropathy?

What is the earliest morphologic abnormality of diabetic nephropathy?

Which light microscopy findings are characteristic of diabetic nephropathy?

Which immunofluorescence microscopy findings are characteristic of diabetic nephropathy?

Which electron microscopy findings are characteristic of diabetic nephropathy?

How is the severity of diabetic nephropathy determined?

What is the role of hypertension in the pathophysiology of nephropathy?

What is the role of central obesity in the pathophysiology of diabetic nephropathy?

What causes diabetic nephropathy?

What is the role of glycemic control in the etiology of diabetic nephropathy?

What is the role of genetics in the development of diabetic nephropathy?

What is the role of serum folic acid in the etiology of diabetic nephropathy?

What is the incidence of diabetic nephropathy in the US?

What is the age distribution for diabetic nephropathy?

What is the prevalence of diabetic nephropathy?

What is the global prevalence of diabetic nephropathy?

How does the prevalence of diabetic nephropathy vary by sex?

How does the prevalence of diabetic nephropathy vary by race?

Which factors are predictors of morbidity and mortality of diabetic nephropathy?

What is a major cause of death in patients with diabetic nephropathy?

What is the incidence of end-stage renal disease (ESRD) in diabetic nephropathy?

Which patients are at high risk for end-stage renal disease (ESRD) from diabetic nephropathy?

What is the frequency of end-stage renal disease (ESRD) in patients with diabetic nephropathy?

How frequently is cardiovascular disease the cause of death in diabetic nephropathy?

What is the importance of patient education for diabetic nephropathy?

Presentation

Which conditions are risk factors for the development of diabetic nephropathy?

Which physical findings of diabetes mellitus (DM) suggest nephropathy?

Which clinical findings are characteristic of nephropathy in type 1 diabetes mellitus (DM)?

Which clinical findings are characteristic of nephropathy in type 2 diabetes mellitus (DM)?

Where can information on complications of diabetes be found?

DDX

Which conditions should be included in the differential diagnosis of diabetic nephropathy?

What are the differential diagnoses for Diabetic Nephropathy?

Workup

How is diabetic nephropathy characterized?

What is the rate of decline of glomerular filtration rate (GFR) suggestive of diabetic nephropathy?

Which assessment of glomerular filtration rate (GFR) is most accurate in patients with diabetic nephropathy?

How is urinalysis used to diagnose diabetic nephropathy?

What is the role of urinalysis in the diagnosis of diabetic nephropathy?

How are blood tests used in the diagnosis of diabetic nephropathy?

What is the role of serum and urinary electrophoresis in the diagnosis of diabetic nephropathy?

What is the role of ultrasonography in the diagnosis of diabetic nephropathy?

When is a renal biopsy indicated for the diagnosis of diabetic nephropathy?

Which changes in the glomeruli are characteristic of diabetic nephropathy?

What is the Renal Pathology Society histologic classification system for diabetic nephropathy?

What is the validity of classifying diabetic nephropathy based on the presence and severity of interstitial fibrosis and tubular atrophy (IFTA)?

How is diabetic nephropathy staged?

Treatment

What are the key components to medical care for diabetic nephropathy?

What is the role of salt reduction in the treatment of diabetic nephropathy?

What is the relationship between hyperglycemia and diabetic nephropathy?

What are the benefits of intensive therapy for diabetic nephropathy?

What are the benefits of strict glycemic and metabolic control in the treatment of diabetic nephropathy?

What is the efficacy of intensive treatment for diabetic nephropathy?

What is the role of DPP-4 inhibitors in the treatment of diabetic nephropathy?

What is the role of alpha-glucosidase inhibitors in the treatment of diabetic nephropathy?

What is the role of SGLT2 inhibitors in the treatment of diabetic nephropathy?

What is the role of GLP-1 agonists in the treatment of diabetic nephropathy?

What is the role of amylin analogs in the treatment of diabetic nephropathy?

What is the role of antihypertensive therapy in diabetic nephropathy?

What is the role of ACE inhibitors in the treatment of diabetic nephropathy?

What is the efficacy of ACE inhibitors as long-term treatment of diabetic nephropathy?

What is the efficacy of ACE inhibitors in the treatment of nephropathy in microalbuminuric type 2 diabetes mellitus (DM)?

In what ways are ACE inhibitors superior to other medications for the treatment of diabetic nephropathy?

What is the antiproteinuric effect of ACE inhibitors in patients with diabetic nephropathy?

How do ACE inhibitors affect the progression of diabetic retinopathy?

What is the role of RAS inhibition in the treatment of diabetic nephropathy?

What are the benefits of ACE inhibitors as a treatment for diabetic nephropathy?

What is the efficacy of ARB therapy for diabetic nephropathy?

What is the role of combined ACE inhibitor and ARB therapy in the treatment of diabetic nephropathy?

What is the role of direct renin inhibitors in the treatment of diabetic nephropathy?

What is the role of endothelin antagonist therapy in the treatment of diabetic nephropathy?

What is the role of renal replacement therapy in the treatment of diabetic nephropathy?

What are the options for renal replacement therapy for diabetic nephropathy?

What is the role of peritoneal dialysis and hemodialysis in the treatment of diabetic nephropathy?

When is renal transplantation indicated in the treatment of diabetic nephropathy?

What is the rationale for combined kidney and pancreas transplantation for diabetic neuropathy?

What is the benefit of pancreas transplantation for treatment of diabetic nephropathy?

When is pancreas transplantation indicated for diabetic nephropathy?

What is the role of urate reduction in the treatment of diabetic nephropathy?

Which dietary modifications are beneficial in the treatment of diabetic nephropathy?

When is restriction in activity indicated in the treatment of diabetic nephropathy?

What are the goals for prevention of diabetic nephropathy?

What is included in the long-term monitoring of diabetic nephropathy?

Where can more information on diabetes complications be found?

What are renal complications of diabetic nephropathy?

Guidelines

What are the American Diabetes Association’s “Standards of Medical Care in Diabetes-2018” regarding diabetic kidney disease?

Medications

Which medications are used in the treatment of diabetic nephropathy?

Which medications in the drug class Antidiabetics, Amylinomimetics are used in the treatment of Diabetic Nephropathy?

Which medications in the drug class Antidiabetics, Glucagon-like Peptide-1 Agonists are used in the treatment of Diabetic Nephropathy?

Which medications in the drug class Antidiabetics, Sodium-Glucose Cotransporter 2 (SGLT2) inhibitors are used in the treatment of Diabetic Nephropathy?

Which medications in the drug class Antidiabetics, Alpha-Glucosidase Inhibitors are used in the treatment of Diabetic Nephropathy?

Which medications in the drug class Antidiabetics, Dipeptyl Peptidase-IV Inhibitors are used in the treatment of Diabetic Nephropathy?

Which medications in the drug class Direct Renin Inhibitors are used in the treatment of Diabetic Nephropathy?

Which medications in the drug class Diuretics are used in the treatment of Diabetic Nephropathy?

Which medications in the drug class Calcium channel blockers are used in the treatment of Diabetic Nephropathy?

Which medications in the drug class Beta-adrenergic blocking agents are used in the treatment of Diabetic Nephropathy?

Which medications in the drug class Angiotensin receptor blockers are used in the treatment of Diabetic Nephropathy?

Which medications in the drug class Angiotensin-converting enzyme inhibitors are used in the treatment of Diabetic Nephropathy?

Which medications in the drug class Thiazolidinedione derivatives are used in the treatment of Diabetic Nephropathy?

Which medications in the drug class Biguanides are used in the treatment of Diabetic Nephropathy?

Which medications in the drug class Sulfonylureas are used in the treatment of Diabetic Nephropathy?

Which medications in the drug class Insulins are used in the treatment of Diabetic Nephropathy?