Update on Diabetic Nephropathy: Core Curriculum 2018

Abstract

Diabetic kidney disease and diabetic nephropathy are the leading cause of end-stage kidney disease in the United States and most developed countries. Diabetes accounts for 30% to 50% of the incident cases of end-stage kidney disease in the United States. Although this represents a significant public health concern, it is important to note that only 30% to 40% of patients with diabetes develop diabetic nephropathy. Specific treatment of patients with diabetic nephropathy can be divided into 4 major arenas: cardiovascular risk reduction, glycemic control, blood pressure control, and inhibition of the renin-angiotensin system (RAS). Recommendations for therapy include targeting a hemoglobin A_1c concentration < 7% and blood pressure < 140/90mmHg with therapy anchored around the use of a RAS-blocking agent. The single best evidence-based therapy for diabetic nephropathy is therapy with a RAS-blocking medication. This Core Curriculum outlines and discusses in detail the epidemiology, pathophysiology, diagnosis, and management of diabetic nephropathy.

Keywords: Diabetic kidney disease; RAS blockade; angiotensin receptor blocker (ARB); angiotensin-converting enzyme inhibitor (ACEi); blood pressure; diabetes; diabetic nephropathy; end-stage kidney disease (ESKD); hemoglobin A(1c) (HbA(1c)); hypertension; renin-angiotensin system (RAS); review.