diabetesnephropathy

Diabetes nephropathy, also known as diabetic kidney disease, is a long‑term complication of poorly controlled diabetes mellitus that progressively damages the kidneys. It is the leading cause of end‑stage renal disease worldwide and is most frequently associated with type 1 and type 2 diabetes in adults.

The pathophysiology involves hyperglycaemia‑induced metabolic and haemodynamic alterations that damage the glomerular filtration barrier. Advanced glycation end products, oxidative stress, and activation of the renin‑angiotensin system contribute to mesangial expansion, basement membrane thickening, and podocyte injury. These changes increase albuminuria and reduce glomerular filtration rate (GFR) over time.

Early clinical stages are often asymptomatic. Microalbuminuria (30–300 mg of albumin per 24 h) is an early marker, followed by macroalbuminuria and declining GFR. Neurological, cardiac, and ocular complications commonly coexist. Diagnosis is based on serial measurements of urine albumin and estimated GFR using serum creatinine, along with exclusion of other kidney diseases.

Management focuses on strict glycaemic, blood‑pressure, and lipid control. Angiotensin‑converting‑enzyme inhibitors or angiotensin‑receptor blockers are first‑line therapies for reducing proteinuria and slowing progression. Lifestyle interventions include smoking cessation, dietary protein restriction, and regular exercise. In advanced stages, renal replacement therapy (dialysis or transplantation) may become necessary.

Risk factors for progression include poor blood‑pressure control, persistent hyperglycaemia, hypertension, dyslipidaemia, obesity, nephrotoxic medications, and genetic predisposition. Public health initiatives emphasize early screening and education to delay onset.

Research is exploring novel therapeutic targets such as endothelin antagonists, sodium‑glucose cotransporter‑2 inhibitors, and anti‑fibrotic agents. Ongoing clinical trials aim to refine risk stratification and expand treatment options to improve renal outcomes for patients with diabetic nephropathy.