Diabetic Nephropathy
Özet
Diabetic nephropathy, or diabetes and chronic kidney disease, is a major microvascular complication and the leading cause of end-stage renal disease worldwide. Developing in approximately 30%-40% of type 1 and 25% of type 2 diabetes patients, its pathogenesis involves complex hemodynamic changes, metabolic pathway alterations, and genetic factors like the ACE gene polymorphism. Diagnosis relies on clinical and laboratory findings, specifically an eGFR below 60 mL/min and/or an albumin/creatinine ratio above 30 mg/g. Annual screening with eGFR and urinary albumin levels is strongly recommended, starting from diagnosis for type 2 diabetes and 5 years post-onset for type 1 diabetes. Renal biopsy is not routinely performed but can be utilized in cases of diagnostic uncertainty or rapid deterioration. Management hinges primarily on strict blood sugar regulation, where metformin and SGLT-2 inhibitors serve as vital first-line therapies, alongside targeted HbA1c goals optimized according to disease stages. Additionally, blood pressure regulation utilizing RAS inhibitors like ACE inhibitors or angiotensin receptor blockers is critical to control hypertension and lower cardiovascular risks. Finally, treating dyslipidemia and exploring novel targeted therapies like finerenone offer promising paths forward.
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