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Diabetic Kidney Disease
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- 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) in Western societies, accounting for 45% of ESRD cases.
- Characterized initially by moderately increased albuminuria, formerly called "microalbuminuria" (30-300 mg albumin/g creatinine); then severely increased albuminuria, formerly called "macroalbuminuria" (>300 mg albumin/g creatinine); followed by renal insufficiency as evidenced by elevated BUN and creatinine; and finally ESRD.
- Histologic findings in DKD includes 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.