Renal disorders in diabetes mellitus, treatment of diabetes in kidney disease

1. Big picture

Diabetes mellitus causes kidney disease in two ways:

1. Diabetic kidney disease / diabetic nephropathy: chronic glomerular and tubulointerstitial injury caused by hyperglycaemia, glomerular hypertension, and RAAS activation.
2. 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 inhibit