Diabetic Kidney Disease
Author: Borissova, Anna-Maria I.
Sofia University “Sv. Kliment Ohridski”
Abstract:
Diabetic Kidney Disease (DKD) is a chronic kidney disease (CKD) associated with diabetes mellitus (DM). The factors that increase the incidence of DKD are the increased incidence of DM and obesity, increasing number of elderly people as well as longer survival. DKD increases the risk of cardiovascular and renal events. In patients with CKD and type 2 diabetes mellitus (T2DM), the incidence of cardiovascular disease (CVD) is highest – 50%, much lower in those with prediabetes – 28% and those with normal glucose tolerance – 22%. Studies on high mortality in T2DM with available DKD for 10 years assess the role of both risk factors – albuminuria and reduced estimated glomerular filtration rate (eGFR). It was found that mortality in the presence of DM alone was 4%, in DM + albuminuria was 18%, in DM + reduced eGFR was 24% and in the presence of DM+ albuminuria + reduced eGFR was 47%. In the recent years, it has been illustrated how, after 10 years of follow-up with appropriate treatment, there is a tendency to reduce the complication of DM – nephropathy and CKD, retinopathy and neuropathy. Increased expression of sodium-glucose transporter 2 (SGLT2) was found in diabetic nephropathy by puncture kidney biopsy. This is what underlies the success of treatment with SGLT2 inhibitors (SGLT2i). On the one hand, SGLT2i exert renal protection through metabolic changes concerning blood glucose, advanced glycation end products (AGEs), reactive oxygen species (ROS) and cytokines. On the other hand, these agents produce significant hemodynamic changes against hyperfiltration and impaired tubulo-glomerular interrelation.
Conclusion: Good knowledge of the intimate mechanisms, by which in DM, the kidney affects the incidence of cardiovascular and renal events, as well as mortality (cardiovascular and all kinds), allows us to make correct and timely therapeutic decisions for their prevention by means of the correct treatment.
Key words: diabetes mellitus, diabetic kidney disease, cardiovascular events, renal events, mortality, SGLT2i
