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Preface and Contents

Diabetic Kidney Disease

Importance and Risk factors

The number of people suffering from diabetes mellitus is increasing all over the world. The impact of a growing number of diabetic patients is an increase in the incidence of diabetic kidney disease, one of the worst complications of diabetes that carries a high mortality.

What is diabetic kidney disease?

Persistent high blood sugar damages small blood vessels of the kidney in long-standing diabetes. This damage initially causes loss of protein in the urine. Subsequently it causes hypertension, swelling and symptoms of gradual damage to the kidney. Finally, progressive deterioration leads to severe kidney failure (ESKD). This diabetes induced kidney problem is known as diabetic kidney disease. Diabetic nephropathy is the medical term used for diabetic kidney disease.

Why is it important to learn about diabetic kidney disease?

  • The incidence of diabetes is growing very fast throughout the world.
  • Diabetic kidney disease (diabetic nephropathy) is the number one leading cause of chronic kidney disease.
  • Diabetes mellitus is responsible for 40-45 % of newly diagnosed patients with end stage kidney disease (ESKD).
  • Therapy of ESKD is costly and may be unaffordable for patients in developing countries.
  • Early diagnosis and treatment can prevent diabetic kidney disease. In diabetics with established chronic kidney disease, meticulous therapy can postpone the need for dialysis and transplantation significantly.
  • There is an increased risk of death from cardiovascular causes in patients with diabetic kidney disease.
  • Early diagnosis of diabetic kidney disease is therefore essential in the care of the diabetic patient.
Diabetes is the most common cause of chronic kidney disease.

How many diabetics develop diabetic kidney disease?

There are two major types of diabetes mellitus, each with different risks of developing diabetic kidney disease.

Type 1 Diabetes (IDDM - Insulin Dependent Diabetes Mellitus):

Type 1 diabetes usually occurs at a young age and insulin is needed to control it. About 30 - 35% of Type 1 diabetics develop diabetic kidney disease.

Type 2 Diabetes (NIDDM - Non Insulin Dependent Diabetes Mellitus):

Type 2 diabetes usually occurs in adults and is controlled without insulin in most of the patients. About 10 - 40% of Type 2 diabetics develop diabetic kidney disease. Type 2 diabetes is the number one cause of chronic kidney disease, responsible for more than one of every three new cases.

Which diabetic patient will develop diabetic kidney disease?

It is difficult to predict which diabetic patient will develop diabetic kidney disease. But major risk factors for its development are:

  • Type 1 diabetes with onset before 20 years of age
  • Poorly controlled diabetes (higher HbA1c levels)
  • Poorly controlled high blood pressure
  • Family history of diabetes and chronic kidney disease
  • Vision problem (diabetic retinopathy) or nerve damage (diabetic neuropathy) due to diabetes
  • Presence of protein in urine, obesity, smoking and elevated serum lipids

When does diabetic kidney disease develop in a diabetic patient?

Diabetic kidney disease takes many years to develop, so it rarely occurs in the first 10 years of diabetes. Symptoms of diabetic kidney disease manifest 15 to 20 years after the onset of Type 1 diabetes. If a diabetic person does not develop diabetic kidney disease in the first 25 years, the risk of it ever developing decreases.

Diabetes is the cause of end stage kidney disease in one out of three patients on dialysis therapy.