Normoalbuminuric chronic kidney disease in diabetes

Abstract

Urinary albumin excretion (UAE) is widely used in clinical practice as indicator of diabetic kidney disease. According to the classical concept of the natural course of diabetic nephropathy, an increase in UAE usually precedes a decline in renal function. Meanwhile, a growing body of evidences indicates a high prevalence of normoalbuminuric chronic kidney disease (NA-CKD) in diabetic subjects, especially among patients with type 2 diabetes. An increase in NA-CKD prevalence can be results of improved glucose, blood pressure, and lipid control, widespread use of renin-angiotensin system blockers, and smoking cessation. It was shown that NA-CKD is more prevalent among women and is associated with arterial hypertension and coronary artery disease. The renal structure in subjects with NA-CKD is more heterogeneous when compared to patients with increased albuminuria, wherein interstitial changes and arteriolosclerosis could be the principal morphological findings, while signs of glomerulopathy may be absent. The prognostic value of NA-CKD needs to be clarified. It was shown that NA-CKD increases the risk of myocardial infarction, stroke and cardiovascular death in patients with diabetes. The search for alternative diagnostic markers for detecting of diabetic kidney disease in the absence of albuminuria, is of practical importance. The evaluations of the markers of tubular damage and interstitial fibrosis, as well as proteomic approaches, are considered as perspective diagnostic and prognostic options in NA-CKD. The study of pathogenesis, pathology, clinical course of NA-CKD in diabetic patients, as well as the development of more specific diagnostic and treatment options is a challenge for future research.

Vascular inflammation, atherosclerosis, and lipid metabolism and the occurrence of non-high albuminuria diabetic kidney disease: A cross-sectional study

“…Diabetic kidney disease (DKD) is the most common microvascular complication in patients with diabetes mellitus (DM) and one of the major causes of mortality in DM patients. 1 According to the American Diabetes Association guidelines, the albumin to creatinine ratio (ACR) and/or estimated glomerular filtration rate (eGFR) should be regularly detected in DM patients, in order to confirm whether kidney injury occurs. 2 In general, there is albuminuria and/ or eGFR decline during and after kidney injury in DM patients, and in most patients, albuminuria present earlier than eGFR decline.…”

SGLT2 inhibitors and kidneys: mechanisms and main effects in diabetes mellitus patients

“…Аналогичной позиции придерживаются и отечественные эксперты, которые в дополненных «Алгоритмах специализированной помощи больным с сахарным диабетом» в 2019 г. у пациентов с ХБП С1-3а также рекомендуют назначение ингибиторов SGLT2 [61].…”

“…У больных с третьей стадией ХБП рекомендуется снижать дозу препаратов или вовсе отменять прием ингибиторов SGLT2, а для пациентов с тяжелой ХБП (С4-5, в т.ч. нуждающихся в диализе) прием этих медикаментов противопоказан [61]. Таким образом, перед началом лечения ингибиторами SGLT2 рекомендуется оценка функции почек.…”