Diabetic Nephropathy (DN) is a microvascular complication of diabetes mellitus characterized by persistent proteinuria, decline in glomerular filtration rate (GFR) and increased morbidity and mortality in diabetics. Patients with uncontrolled diabetes and increase in blood pressure are at high risk of developing nephropathy. Age, long duration of diabetes, elevated BP, poor glycaemic control and presence of retinopathy were significantly associated with the progression of diabetic nephropathy. Multiple mechanisms contribute to the development and outcomes of diabetic nephropathy, such as an interaction between hyperglycemia induced metabolic and hemodynamic changes and genetic predisposition, which sets the stage for kidney injury.
Screening for microalbuminuria is recommended for type 2 diabetic subjects from the day of diagnosis on annual basis. While in type 1 diabetic subjects, annual screening should be done after 5 years of diagnosis of type 1 DM.
Early detection of DN, the multifactorial approach targeting the main risk factors (hyperglycemia, hypertension, dyslipidemia and smoking), and the use of renoprotective agents such as the drugs that act on the renin-angiotensin-aldosterone system, may delay progression of kidney disease in DM, besides reducing cardiovascular mortality.
Dr. Arvind Gupta is Director and Consultant Physician at the Jaipur Diabetes Research Centre, India.
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