Diabetic Kidney Disease

Daphne H. Knicely, M.D., Donna Myers, M.D.


  • Diabetic kidney disease (DKD) is one of the common long-term, microvascular complications of diabetes.
  • DKD remains the most common cause of end-stage renal disease (ESRD), accounting for about half of all ESRD cases.[72]
  • Characterized initially by moderately increased urine albumin-to-creatinine ratio (UACR), formerly called "microalbuminuria" (30-300 mg albumin/g creatinine); then severely increased UACR, formerly called "macroalbuminuria" (>300 mg albumin/g creatinine); followed by renal insufficiency as evidenced by elevated BUN and creatinine; and finally ESRD.[1][2]
  • Histologic findings in DKD include basement membrane thickening, mesangial expansion, nodular glomerulosclerosis with classic Kimmelstein-Wilson nodules (late finding), specific vascular lesions including arterial hyalinosis, and tubulointerstitial changes such as development of fibrosis. Ultimately, this results in progressive albuminuria, reduction in glomerular filtration rate (GFR), elevation of arterial blood pressure and fluid retention.[20][17]

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Last updated: March 3, 2019