Renal disorders in diabetes mellitus, treatment of diabetes in kidney disease
1. Big picture
Diabetes mellitus causes kidney disease in two ways:
- Diabetic kidney disease / diabetic nephropathy: chronic glomerular and tubulointerstitial injury caused by hyperglycaemia, glomerular hypertension, and RAAS activation.
- Other renal disorders common in diabetes: urinary tract infections, papillary necrosis, acute kidney injury, renovascular disease, hyperkalaemic renal tubular acidosis, and non-diabetic glomerular disease.
The examiner wants this logic:
Diabetes → screen for albuminuria and eGFR → decide typical diabetic nephropathy vs atypical renal disease → protect kidney with glycaemic control + blood pressure control + RAAS blockade + SGLT2 inhibitor → adjust antidiabetic drugs to eGFR.
Modern guidelines emphasize combined risk-based management using eGFR and albuminuria, and recommend kidney-protective treatment such as RAAS blockade and SGLT2 inhibitors in appropriate patients with diabetic CKD. ([Kidney International][1])
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