Materiały źródłowe

• #1 Diabetic Nephropathy – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK534200/

  Endothelial cell damage is one of the earliest pathological changes in diabetic nephropathy. […] Podocytes are essential components of the glomerular filtration barrier, and their injury leads to proteinuria. […] The polyol pathway contributes to diabetic nephropathy through the accumulation of fructose and sorbitol, glucose byproducts that increase osmotic pressure, leading to edema and cell membrane rupture. […] Genetics is crucial for the development of diabetic nephropathy, with both genetic and environmental factors contributing to its onset. […] Approximately 30% to 40% of patients with diabetes mellitus develop diabetic nephropathy. […] The 3 main pathological lesions of diabetic nephropathy include diffuse mesangial cell expansion, GBM thickening, and arteriolar hyalinization.

• #1 Diabetic nephropathy (kidney disease) | Diabetes UK

  https://www.diabetes.org.uk/about-diabetes/looking-after-diabetes/complications/kidneys-nephropathy

  Diabetic nephropathy is the name given to kidney damage caused by diabetes. […] What causes diabetic kidney disease? […] When you have high blood glucose levels, also called blood sugar levels, this can damage the small blood vessels and tiny filters in your kidneys. […] High blood pressure can do this too. Damage to these filters can cause them to leak and not work as well, and when this happens, abnormal amounts of protein from the blood can leave your body in your urine. This is often an early sign of kidney disease. […] Almost one in five people with diabetes will need treatment for diabetic nephropathy. […] People with type 2 diabetes and kidney disease might have a different type of medication called sodium-glucose cotransporter-2 inhibitors, or SGLT-2 inhibitors. […] This group of medications prevent the kidneys from reabsorbing glucose back into the blood, which helps lower blood sugar levels in people with type 2 diabetes. They also help protect the kidneys and can slow down the progression of kidney disease. […] If you do develop end-stage kidney disease and your kidneys fail, your treatment options include dialysis or a kidney transplant.

• #1 Diabetes and kidney disease Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/diabetes-and-kidney-disease

  Diabetic nephropathy; Nephropathy – diabetic; Diabetic glomerulosclerosis; Kimmelstiel-Wilson disease […] Kidney disease or kidney damage often occurs over time in people with diabetes. This type of kidney disease is called diabetic nephropathy. […] In people with diabetes, the nephrons slowly thicken and become scarred over time. The nephrons begin to leak, and protein (albumin) passes into the urine. This damage can happen years before any symptoms of kidney disease begin. Some people who have type 2 diabetes that develops slowly already have kidney damage when they are first diagnosed. […] Kidney damage is more likely if you: Have uncontrolled blood sugar (glucose) […] Diabetic kidney disease is a major cause of sickness and death in people with diabetes. It can lead to the need for dialysis or a kidney transplant.

• #1 Pathogenesis of Diabetic Nephropathy – Chronic Kidney Disease and Type 2 Diabetes – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK571720/

  Our understanding of the natural history of diabetic nephropathy has emerged largely from patients with type 1 diabetes. However, histological manifestations among those with type 2 diabetes are similar. Both the clinical manifestations and the histological appearances of kidney disease associated with diabetes have been well characterized. The pathogenesis of diabetic nephropathy is initiated and maintained by four causal factors, which can be classified broadly into metabolic, hemodynamic, growth, and proinflammatory or profibrotic factors. These pathogenetic factors produce lesions in various kidney compartments: glomeruli, tubuli, interstitium, and vasculature. A complex series of molecules, receptors, enzymes, and transcription factors participate in the process that drives the earliest stages of kidney disease to an enlarged kidney with hypertrophy, expanded extracellular matrix (ECM), glomerulosclerosis, vascular hyalinosis, interstitial fibrosis and tubular atrophy, and loss of function culminating in end-stage renal disease (ESRD).

• #1 Diabetic Nephropathy – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK534200/

  Diabetic nephropathy is the leading cause of end-stage renal disease in developed countries, including the United States. […] The primary pathological features of diabetic kidney disease (DKD) include glomerular hypertrophy, glomerular basement membrane thickening, effacement of podocyte foot processes, and mesangial matrix expansion. […] Hyperglycemia triggers the production of reactive oxygen species and activates several molecular pathways. […] These interconnected pathways drive the onset and progression of diabetic nephropathy by promoting inflammation, fibrosis, endothelial dysfunction, and podocyte damage. […] Hyperglycemia leads to the production of glucose degradation products and glycation end products, intensifying inflammation and promoting macrophage infiltration in the kidneys, a key factor in diabetic nephropathy.

• #1 Diabetic nephropathy – Wikipedia

  https://en.wikipedia.org/wiki/Diabetic_nephropathy

  Diabetic nephropathy, also known as diabetic kidney disease, is the chronic loss of kidney function occurring in those with diabetes mellitus. Diabetic nephropathy is the leading cause of chronic kidney disease (CKD) and end-stage renal disease (ESRD) globally. […] Pathophysiologic abnormalities in diabetic nephropathy usually begin with long-standing poorly controlled blood glucose levels. […] The disease progression of diabetic nephropathy involves various clinical stages: hyperfiltration, microalbuminuria, macroalbuminuria, nephrotic proteinuria to progressive chronic kidney disease leading to end-stage renal disease (ESRD). […] The pathophysiology of diabetic nephropathy is thought to involve an interaction between hemodynamic and metabolic factors. […] Hemodynamic factors include an increase in systemic and intraglomerular pressure, as well as the over-activation of the RAAS.

• #1 Pathophysiology of Diabetic Kidney Disease – European Medical Journal

  https://www.emjreviews.com/nephrology/article/pathophysiology-of-diabetic-kidney-disease-j120121/

  The kidneys in a diabetic environment undergo many changes, from initial renal enlargement to vasoconstriction, endothelial and tubular cell injury, to eventual renal fibrosis. […] The earliest changes in DKD are due to hyperfiltration in the glomerulus, causing thickening and stiffness of the glomerular basement membrane from sheer pressure and deposition of extracellular matrix. […] Podocyte injury has been shown to mimic diabetic changes even in absence of hyperglycaemia, which indicates that podocyte injury is the key in development of DKD. […] Hyperglycaemia is probably the instigator for all the downstream effects leading to DKD.

• #1 Pathogenesis of Diabetic Nephropathy – Chronic Kidney Disease and Type 2 Diabetes – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK571720/

  The earliest changes are triggered by metabolic factors, namely hyperglycemia. Damage resulting from hyperglycemia can occur by alteration of tissues or can be induced by products of glucose metabolism. Glycation of tissues provokes downstream injury by several mechanisms that can be broadly classified into receptor-mediated and nonreceptor-mediated categories. Glycation leads to activation of receptors on cells, the best characterized of which is the receptor of advanced glycation end products (RAGE) that trigger the synthesis and release of nuclear factor B (NFB) and the generation of reactive oxygen species (ROS). […] Inflammation and fibrosis are important causes of diabetic nephropathy. Whether this is causal or in response to injury remains a matter of debate. However, there is a strong relation between the degree of infiltration of macrophages and subsequent occurrence of tubular interstitial fibrosis and progression of diabetic kidney disease. Macrophages are attracted to the kidney by a variety of mechanisms.

• #1 Pathophysiology of Diabetic Kidney Disease – European Medical Journal

  https://www.emjreviews.com/nephrology/article/pathophysiology-of-diabetic-kidney-disease-j120121/

  Hyperglycaemia initiates its effects on the kidney by disturbing the osmotic forces. […] Measures taken to control hyperglycaemia have been proven to inhibit DKD progression, myocardial infarction, and mortality. […] Hyperglycaemia and SGLT2-assisted decreased distal sodium delivery leads to activation of RAAS, producing efferent arteriolar vasoconstriction and afferent vasodilation, and amplifying intraglomerular hypertension. […] Diabetes is associated with dysregulation of multiple metabolic pathways. […] Hyperglycaemia can lead to oxidative stress and hypoxia in multiple ways. […] Inflammation plays a vital role in the pathogenesis of DKD. […] Hyperglycaemia leads to higher levels of glycan and galactosamine-bound substances that are recognised by these receptors. […] Hyperglycaemia and its effects cause DNA damage, and display effects of ageing in patients with diabetes by causing chromosomal telomere shortening, resulting in proteinuria and DKD progression.

• #1 Diabetes and Renal Complications: An Overview on Pathophysiology, Biomarkers and Therapeutic Interventions

  https://www.mdpi.com/2227-9059/12/5/1098

  The overproduction of ROS due to hyperglycaemia stimulates the activation and recruitment of intracellular signalling molecules including cytokines, growth factors and transcription factors which drive the pathological pathways of renal inflammation and fibrosis. […] In DKD, inflammation plays an important role. It is driven by multiple pathways including oxidative stress, activation of transcription pathways such as JAK/STAT and transcription factors including nuclear factor κB (NF-κB) and the activation of pro-inflammatory cytokines. […] Renal fibrosis is recognised as a key hallmark in the progression of DKD, particularly in driving renal structural changes especially extracellular matrix (ECM) accumulation causing renal injury. […] Albuminuria is recognised as an early predictor for the progression of DKD. The variety of pathological mechanisms including oxidative stress, renal inflammation, fibrosis and haemodynamic alterations lead to the damage of the highly regulated glomerular filtration barrier, compromising the filtration process.

• #1 Pathogenesis of Diabetic Nephropathy – Chronic Kidney Disease and Type 2 Diabetes – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK571720/

  The pathogenesis of diabetic nephropathy involves metabolic, hemodynamic, growth, and inflammatory and fibrotic factors. The relative contributions of these factors vary among patients, over time, and even in different compartments of the kidney, and genetic and environmental factors can modify the appearance of the kidney lesions.

• #1 Diabetic Nephropathy: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/238946-overview

  Diabetic nephropathy is a clinical syndrome characterized by the following: Persistent albuminuria (300 mg/d or 200 g/min) that is confirmed on at least 2 occasions 3-6 months apart […] The exact cause of diabetic nephropathy is unknown, but various postulated mechanisms are hyperglycemia (causing hyperfiltration and renal injury), advanced glycation products, and activation of cytokines. […] Evidence suggests that when there is insulin resistance, the pancreas is forced to increase its insulin output, which stresses the cells, eventually resulting in -cell exhaustion. […] Hyperglycemia also increases the expression of transforming growth factor- (TGF-) in the glomeruli and of matrix proteins, specifically stimulated by this cytokine. […] Familial or perhaps even genetic factors also play a role. Certain ethnic groups, particularly African Americans, persons of Hispanic origin, and American Indians, may be particularly disposed to renal disease as a complication of diabetes.

• #1 Diabetic Nephropathy – a Review of Risk Factors, Progression, Mechanism, and Dietary Management

  https://www.biomolther.org/journal/view.html?uid=1312&vmd=Full&

  An early symptom of DN includes high excretion of albumin in urine, glomerular and renal hypertrophy, hyperfiltration, and mesangial expansion with ECM proteins aggregation such as fibronectin, laminin, and collagen. […] Risk factors were defined as two types for DN: modifiable and non-modifiable factors. Modifiable factors include hypertension, glycemic level management, and dyslipidemia. Additionally, smoking was demonstrated as an additional modifiable risk factor. Non-modifiable factors are race, age, gestation, genetic profile, and sex. Patients with a family history of DN were more susceptible to develop the condition. A race such as the American population of Mexicans, Africans, and Pima people of Native Americans showed higher rates of developing DN. […] Genes, such as ACE, APOC1, GREM1, UNC13B, ALR2, APOE, CARS, CPVL/CHN2, eNOS, EPO, FRMD3, HSPG2, and VEGF, are identified for the hereditary reasons of DN. High levels of HbA1C, proteinuria, systolic blood pressure, and habits increase the risk of DN in DM patients.

• #1 Diabetic Nephropathy: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/238946-overview

  It has been argued that the genetic predisposition to diabetes that is so frequent in Western societies, and even more so in minorities, reflects the fact that in the past, insulin resistance conferred a survival advantage (the so-called thrifty genotype hypothesis). […] Some evidence has accrued for a polymorphism in the gene for angiotensin-converting enzyme (ACE) in either predisposing to nephropathy or accelerating its course. […] A study by Bherwani et al suggested that an association exists between decreased serum folic acid levels and diabetic nephropathy.

• #1 Diabetic Nephropathy – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK534200/

  A longer duration of diabetes mellitus, poor glycemic control, and uncontrolled hypertension are significant risk factors for developing diabetic nephropathy. […] Diabetic nephropathy is diagnosed by persistent albuminuria on 2 or more occasions, separated by at least 3 months, using early morning urine samples. […] The management of diabetic nephropathy focuses on 4 key areas, including cardiovascular risk reduction, glycemic control, blood pressure (BP) control, and inhibition of the renin-angiotensin system (RAS). […] The KDIGO guidelines recommend a BP target of less than 120/80 mm Hg for individuals with diabetes, allowing for individualization based on patient-specific factors. […] The use of ACEIs or ARBs in cases of albuminuria without hypertension remains insufficiently studied and should be considered on an individual basis. […] Diabetic nephropathy is associated with high morbidity and mortality.

• #1 Diabetic Nephropathy – Symptoms, Causes, Treatment & Prevention PACE Hospitals – Best Hospitals in Hitech City, Hyderabad, India | Near Madhapur, Kukatpally, KPHB, Kondapur, Gachibowli, Jubilee Hills, Banjara HillsPACE Hospitals Contact N

  https://www.pacehospital.com/diabetic-nephropathy-symptoms-causes-prevention-and-treatment

  Diabetes has the potential to harm body’s nerves which may make it difficult to urinate. A full bladder can cause pressure that builds up and damages the kidneys. High blood pressure is a common side effect of diabetes that can harm the kidneys. […] Various risk factors may influence the onset and progression of diabetic nephropathy, which can be classified into two categories, modifiable and non-modifiable risk factors. […] The longer a person has diabetes, the higher the risk of developing diabetic nephropathy. Patients with diabetes for over 10 years are at significantly increased risk. […] Advanced age is associated with a higher likelihood of diabetic nephropathy, independent of diabetes duration. […] Family history and certain genetic markers have been linked to an increased risk of diabetic nephropathy. Ethnic background also plays a role, with higher incidences observed in African American population.

• #1 Diabetic Kidney Disease: Symptoms, Diagnosis, and Complications

  https://patient.info/diabetes/diabetes-mellitus-leaflet/diabetic-kidney-disease

  Diabetic kidney disease is the leading cause of end-stage kidney disease in the UK. […] There are some things that are known to increase the risk of getting diabetic kidney disease: A poor control of your blood sugar (glucose) levels. […] Diabetic kidney disease can affect anyone with diabetes. […] The risk of developing end-stage kidney disease differs from person to person. Having high levels of protein in the urine (proteinuria) increases this risk. […] Diabetic kidney disease is much more common in South Asian and Black people with diabetes than in white people. We don’t fully understand why this is.

• #1 Diabetic Nephropathy: Causes, Symptoms, Treatment, Outlook, and More

  https://www.verywellhealth.com/diabetic-nephropathy-8665334

  Other factors common in people with diabetes, like inflammation and high blood pressure, may also play a role. […] However, diabetic nephropathy doesnt occur right when you first get diabetes. It may take around 10 years to develop, though this can vary greatly. […] Some factors increase the chance that youll develop diabetic nephropathy. […] For example, you have a higher risk of diabetic nephropathy if you are male or advanced in age. […] People whove had diabetes for a long time also have higher risks, as do people who already have other diabetes complications, like retinopathy. […] High blood pressure is common in people who have diabetes and can further damage the kidneys, so some people also need medications to lower their blood pressure. […] A significant number of people with diabetic nephropathy do eventually develop end-stage disease.

• #1 Diabetic Nephropathy – Genitourinary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/genitourinary-disorders/glomerular-disorders/diabetic-nephropathy

  Diabetic nephropathy is glomerular sclerosis and fibrosis caused by the metabolic and hemodynamic changes of diabetes mellitus. It manifests as slowly progressive albuminuria with worsening hypertension and chronic kidney disease. […] Diabetic nephropathy is the most common cause of nephrotic syndrome in adults. Diabetic nephropathy is also the most common cause of kidney failure worldwide, accounting for up to half of new cases in the United States. The lifetime prevalence of kidney failure is approximately 40% among patients with diabetes mellitus. […] Other risk factors include the following: Duration and degree of hyperglycemia, Hypertension, Dyslipidemia, Cigarette smoking, Certain polymorphisms affecting the renin-angiotensin-aldosterone axis, Family history of diabetic nephropathy, Genetic variables (decreased number of glomeruli).

• #1 Diabetic Nephropathy – Symptoms, Causes, Treatment & Prevention PACE Hospitals – Best Hospitals in Hitech City, Hyderabad, India | Near Madhapur, Kukatpally, KPHB, Kondapur, Gachibowli, Jubilee Hills, Banjara HillsPACE Hospitals Contact N

  https://www.pacehospital.com/diabetic-nephropathy-symptoms-causes-prevention-and-treatment

  Elevated blood glucose levels are a primary risk factor. Maintaining optimal glycemic control is crucial to prevent kidney damage. […] High blood pressure significantly increases the risk of diabetic nephropathy. Effective management of blood pressure can help reduce the risk of progression from mild to severe kidney disease. […] Diabetes-related kidney damage can be more likely in those with elevated cholesterol and triglyceride levels. […] Smoking is one established risk factor for diabetic nephropathy. Giving up smoking can delay the onset of diabetic nephropathy and lower the incidence of microalbuminuria. […] Diabetic kidney disease (DKD) can be prevented or slowed down by addressing recognised risk factors along with the preventive strategies such as glycaemic control (maintaining optimum blood sugar levels).

• #1 Diabetic Nephropathy: Symptoms, Causes, Diagnosis and treatment PACE Hospitals – Best Hospitals in Hitech City, Hyderabad, India | Near Madhapur, Kukatpally, KPHB, Kondapur, Gachibowli, Jubilee Hills, Banjara HillsPACE Hospitals Contact N

  https://www.pacehospital.com/diabetic-nephropathy

  Diabetic Nephropathy or Diabetic Kidney Disease is a type of kidney disease that occurs in some people who have diabetes. […] Leading cause of kidney disease is diabetes, 30 percent of patients with Type 1 diabetes and 10 to 40 percent of those with Type 2 diabetes suffer from Diabetic kidney disease. […] High blood sugar, can damage the blood vessels in your kidneys due to that they don’t work as well. Many people with diabetes also develop high blood pressure, which can also damage your kidneys. […] Your risk of Diabetic Kidney Disease is greater if you have type 1 or type 2 diabetes. Several other factors may increase your risk of Diabetic Kidney Disease that includes: Smoking, High blood pressure (hypertension), High cholesterol (hypercholesterolemia), High blood sugar (hyperglycemia), A family history of kidney disease and diabetes.

• #1 Diabetic Nephropathy – Genitourinary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/genitourinary-disorders/glomerular-disorders/diabetic-nephropathy

  Diabetic nephropathy begins as glomerular hyperfiltration (increased glomerular filtration rate [GFR]); GFR normalizes with early kidney injury and mild hypertension, which worsens over time. […] Other urinary tract abnormalities commonly occurring with diabetic nephropathy that may accelerate the decline of kidney function include papillary necrosis, type IV renal tubular acidosis, and urinary tract infections. […] Prognosis is good for patients who are meticulously treated and monitored. Such care is often difficult in practice, however, and most patients slowly lose kidney function; even prehypertension (BP 120 to 139/80 to 89 mm Hg) or stage 1 hypertension (BP 140 to 159/90 to 99 mm Hg) may accelerate injury.

• #1 Diabetic Nephropathy: Symptoms, Causes, Diagnosis and treatment PACE Hospitals – Best Hospitals in Hitech City, Hyderabad, India | Near Madhapur, Kukatpally, KPHB, Kondapur, Gachibowli, Jubilee Hills, Banjara HillsPACE Hospitals Contact N

  https://www.pacehospital.com/diabetic-nephropathy

  The risk of developing diabetic nephropathy (DN) starts with albuminuria, progressing from microalbuminuria to macroalbuminuria. […] The prevalence of DN is mostly in Type 2 diabetic patients, 20-40% with microalbuminuria (MA) progress to manifested nephropathy after 20 years from the onset of diabetes; approximately 20% develop end-stage renal disease (ESRD).

• #1 Diabetic nephropathy: How diabetes affects the kidneys

  https://www.diabinfo.de/en/living-with-diabetes/complications/kidneys.html

  A significant influencing factor for kidney damage associated with diabetes is blood sugar. […] High blood pressure can be both a trigger for kidney damage as well as a consequence. […] Elevated albumin excretion and loss of renal function are also independent risk factors for cardiovascular disease and death. […] Good blood sugar management and strict monitoring of blood pressure levels are the most important factors to prevent or delay the progression of diabetic kidney disease. […] High blood pressure increases the risk of further kidney damage and the onset of cardiovascular disease. […] The incidence of diabetic nephropathy is approximately 20 to 40 percent for people with diabetes.

• #1 Diabetic Nephropathy (Kidney Disease) | University Hospitals

  https://www.uhhospitals.org/health-information/health-and-wellness-library/article/diseases-and-conditions/diabetic-nephropathy-kidney-disease

  Diabetic kidney disease (DKD) is kidney disease that is due to diabetes. It is also called diabetic nephropathy. Nephropathy means your kidneys aren’t working normally. […] Type 1 and type 2 diabetes are the most common causes of kidney disease. […] High blood sugar linked to diabetes damages the kidney in several different ways. Mainly, it damages the blood vessels that filter the blood to make urine. […] People with diabetes also often develop high blood pressure. This can also damage your kidneys. […] Diabetic kidney disease is kidney disease that is due to diabetes. […] Both type 1 and type 2 diabetes are the most common cause of kidney disease.

• #1 Diabetic nephropathy (kidney disease) | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/diabetic-nephropathy-kidney-disease

  Diabetic nephropathy happens when diabetes damages blood vessels and other cells in the kidneys. […] Diabetic nephropathy is a common complication of type 1 and type 2 diabetes. […] Over time, diabetes that isn’t well controlled can damage blood vessels in the kidneys that filter waste from the blood. This can lead to kidney damage and cause high blood pressure. […] High blood pressure can cause more kidney damage by raising the pressure in the filtering system of the kidneys.

• #1 Diabetic nephropathy – Wikipedia

  https://en.wikipedia.org/wiki/Diabetic_nephropathy

  Metabolic factors include the formation of advanced glycation end-products (AGEs), which have a central role in the pathophysiology of many of the complications of diabetes mellitus, including cardiovascular complications. […] Diabetic nephropathy is the most common cause of end-stage renal disease, which may require hemodialysis or even kidney transplantation. […] Diabetic nephropathy affects approximately a third of patients with type 1 and type 2 diabetes mellitus. Diabetic nephropathy is responsible for about a third of cases of ESRD worldwide, and an even larger fraction in the developed countries.

• #1

  https://journals.lww.com/md-journal/fulltext/2023/05260/acute_kidney_injury_in_diabetic_patients__a.7.aspx

  Diabetes mellitus has been demonstrated to be an independent risk factor in a recent meta-analysis of sepsis-related AKI. […] The pathophysiologic mechanisms causing diabetes-related kidney damage are multifactorial. […] It is believed that in uncontrolled diabetes, renal vasculature dysregulation is the primary factor contributing to glomerular hyperfiltration. […] Persistent glomerular hyperfiltration causes intraglomerular hypertension, followed by glomerulosclerosis, which causes a progressive decline in kidney function and eventually DKD. […] Diabetic patients are at higher risk of AKI than nondiabetic patients, which can be attributed to diabetes, chronic kidney disease, hyperglycemic crisis, drugs that is, ACE inhibitors and sodium-glucose cotransporter-2 (SGLT2) inhibitors, associated cardiovascular disease and heart failure, and previous AKI episodes. […] In summary, AKI is a complication of diabetes mellitus.

• #1 Diabetes and Renal Complications: An Overview on Pathophysiology, Biomarkers and Therapeutic Interventions

  https://www.mdpi.com/2227-9059/12/5/1098

  The pathophysiology of DKD is multifactorial in that the diabetes-induced hyperglycaemia drives various pathological pathways within the kidney which can be broadly characterised as haemodynamic, metabolic, inflammatory, fibrotic and oxidative stress as the major determinant of this pathological process. […] The key features of diabetes-mediated renal complications include morphological and functional alterations to renal glomeruli and tubules leading to mesangial expansion, glomerulosclerosis, homogenous thickening of the glomerular basement membrane (GBM), albuminuria, tubulointerstitial fibrosis and progressive decline in renal function. […] Chronic hyperglycaemia induces oxidative stress via enhanced reactive oxygen species (ROS) production and diminished antioxidant defence in DKD.

• #1

  https://journals.lww.com/md-journal/fulltext/2023/05260/acute_kidney_injury_in_diabetic_patients__a.7.aspx

  Diabetes mellitus (DM) is the most common cause of chronic kidney disease, which leads to end-stage renal failure worldwide. […] Diabetes is a distinct risk factor for acute kidney injury (AKI) and AKI is associated with faster advancement of renal disease in patients with diabetes. […] One significant microvascular sequelae of diabetes are diabetic nephropathy (DN) or diabetic kidney disease (DKD). […] Risk factors for the progression of CKD include gender, racial disparities, hereditary factors, concurrent comorbid illnesses, for example, diabetes mellitus (DM), metabolic abnormalities, and previous episodes of acute kidney injury (AKI), etc. […] Diabetes is a distinct risk factor for AKI. […] There have been other studies that showed that patients with diabetes may be more prone to AKI.

• #1

  https://journals.lww.com/md-journal/fulltext/2023/05260/acute_kidney_injury_in_diabetic_patients__a.7.aspx

  Generally, there is a significant correlation between AKI and the emergence of CKD and ESRD. […] In a cohort of 4082 patients with diabetes, Thakar et al showed that AKI episodes were related to a cumulative likelihood of developing progressive CKD, regardless of the presence of any other significant risk factors for progression. […] Diabetic patients had higher rates of AKI than controls (48.6% vs 17.2%, respectively). […] The AKI risk among diabetic patients was 5 times higher than that of controls, even in the absence of CKD. […] Diabetic patients, particularly those who developed DN, are more prone to contrast-induced injury. […] Diabetes and contrast-induced acute kidney injury (CI-AKI) are mutually causative, causing kidney function to deteriorate further. […] According to data, the incidence of Contrast-induced AKI ranges from 5.7% to 29.4% in diabetes patients and is approximately 13% in nondiabetic patients.

• #1 Anaemia in Patients with Diabetic Nephropathy – Prevalence, Causes and Clinical Consequences | ECR Journal

  https://www.ecrjournal.com/articles/anaemia-patients-diabetic-nephropathy-prevalence-causes-and-clinical-consequences?language_content_entity=en

  The prognosis for diabetics with renal insufficiency is still unfavourable even today. […] Patients with diabetes in particular seem to have a higher risk of developing anaemia when kidney function is impaired. […] The causes underlying the frequent occurrence of anaemia among diabetics have not yet been clarified completely. […] Apart from an inadequate iron supply, a disturbed regulation of EPO synthesis represents a significant factor in anaemia development among diabetics with renal dysfunction. […] More recent studies assume that the progression of the nephropathy is promoted by the anaemia too. […] Amongst diabetics with nephropathy, the appearance of anaemia therefore identifies a group with an excessively high cardiovascular and renal risk.

• #1 Pathophysiology of Diabetic Kidney Disease – European Medical Journal

  https://www.emjreviews.com/nephrology/article/pathophysiology-of-diabetic-kidney-disease-j120121/

  Diabetic kidney disease (DKD) has been an immense burden on the healthcare system, and is the leading cause of end stage kidney disease worldwide. […] DKD involves various intersecting pathways that lead to progressive kidney damage. […] Forty percent of patients with diabetes will have subsequent diabetic kidney disease (DKD). […] DKD damages the podocytes, glomeruli, and the tubules, as well as causing changes on the cellular level including mitochondrial injury and epigenetic changes. […] The end result of uncontrolled hyperglycaemia in the kidney is nephron death. […] The inception of the renal involvement in this disorder is the onset of uncontrolled levels of blood glucose. […] Hyperglycaemia leads to hyperfiltration, which is followed by metabolic, hormonal, haemodynamic, inflammatory and epigenetic changes.

• #1 Diabetic kidney disease | Nature Reviews Disease Primers

  https://www.nature.com/articles/nrdp201518

  The kidney is arguably the most important target of microvascular damage in diabetes. A substantial proportion of individuals with diabetes will develop kidney disease owing to their disease and/or other co-morbidity, including hypertension and ageing-related nephron loss. […] Consequently, preventing and managing CKD in patients with diabetes is now a key aim of their overall management. […] Indeed, the major decline in the incidence of diabetic kidney disease (DKD) over the past 30 years and improved patient prognosis are largely attributable to improved diabetes care. […] However, there remains an unmet need for innovative treatment strategies to prevent, arrest, treat and reverse DKD. […] In this Primer, we summarize what is now known about the molecular pathogenesis of CKD in patients with diabetes and the key pathways and targets implicated in its progression. […] Finally, we explore the opportunities to develop new interventions through urgently needed investment in dedicated and focused research.

• #2 Diabetes-Related Nephropathy: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/24183-diabetic-nephropathy

  Diabetes-related nephropathy is a progressive disease that affects your kidneys. […] Long-standing diabetes causes diabetes-related nephropathy. […] Diabetes causes diabetes-related nephropathy. If you have diabetes, your body cant properly process the blood sugar (glucose) from the foods and drinks you consume. Extra glucose in your bloodstream may damage the glomerular membranes as well as other parts of the nephron. […] Type 1 or type 2 diabetes causes diabetes-related nephropathy. […] Diabetes-related nephropathy is common. Its the most common cause of end-stage renal (kidney) disease in the world. […] About 40% of people who have diabetes develop diabetes-related nephropathy. […] The best way to prevent diabetes-related nephropathy is to manage your diabetes and lower your blood pressure. […] Diabetes-related nephropathy may advance to kidney failure, which may be fatal. […] Diabetes-related nephropathy is a condition that damages your kidneys. It may lead to kidney failure, which can be fatal.

• #2 Diabetic Nephropathy: Symptoms, Diagnosis, and Treatment

  https://www.healthline.com/health/kidney-disease/diabetic-nephropathy-symptoms

  Diabetes is one of the most common causes of chronic kidney disease (CKD). About 1 in 3 people with diabetes develop CKD. […] The high levels of glucose (sugar) in the blood of people with type 1 and type 2 diabetes cause the kidneys to filter an excess amount of blood. […] Over time, this extra work can damage the blood vessels in the kidneys, causing them to leak albumin and other proteins into the urine. This can lead to diabetic nephropathy.

• #2 Pathogenesis of Diabetic Nephropathy – Chronic Kidney Disease and Type 2 Diabetes – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK571720/

  The earliest changes are triggered by metabolic factors, namely hyperglycemia. Damage resulting from hyperglycemia can occur by alteration of tissues or can be induced by products of glucose metabolism. Glycation of tissues provokes downstream injury by several mechanisms that can be broadly classified into receptor-mediated and nonreceptor-mediated categories. Glycation leads to activation of receptors on cells, the best characterized of which is the receptor of advanced glycation end products (RAGE) that trigger the synthesis and release of nuclear factor B (NFB) and the generation of reactive oxygen species (ROS). […] Inflammation and fibrosis are important causes of diabetic nephropathy. Whether this is causal or in response to injury remains a matter of debate. However, there is a strong relation between the degree of infiltration of macrophages and subsequent occurrence of tubular interstitial fibrosis and progression of diabetic kidney disease. Macrophages are attracted to the kidney by a variety of mechanisms.

• #2 Diabetic Nephropathy – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK534200/

  Endothelial cell damage is one of the earliest pathological changes in diabetic nephropathy. […] Podocytes are essential components of the glomerular filtration barrier, and their injury leads to proteinuria. […] The polyol pathway contributes to diabetic nephropathy through the accumulation of fructose and sorbitol, glucose byproducts that increase osmotic pressure, leading to edema and cell membrane rupture. […] Genetics is crucial for the development of diabetic nephropathy, with both genetic and environmental factors contributing to its onset. […] Approximately 30% to 40% of patients with diabetes mellitus develop diabetic nephropathy. […] The 3 main pathological lesions of diabetic nephropathy include diffuse mesangial cell expansion, GBM thickening, and arteriolar hyalinization.

• #2 Diabetic Nephropathy: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/238946-overview

  Diabetic nephropathy is a clinical syndrome characterized by the following: Persistent albuminuria (300 mg/d or 200 g/min) that is confirmed on at least 2 occasions 3-6 months apart […] The exact cause of diabetic nephropathy is unknown, but various postulated mechanisms are hyperglycemia (causing hyperfiltration and renal injury), advanced glycation products, and activation of cytokines. […] Evidence suggests that when there is insulin resistance, the pancreas is forced to increase its insulin output, which stresses the cells, eventually resulting in -cell exhaustion. […] Hyperglycemia also increases the expression of transforming growth factor- (TGF-) in the glomeruli and of matrix proteins, specifically stimulated by this cytokine. […] Familial or perhaps even genetic factors also play a role. Certain ethnic groups, particularly African Americans, persons of Hispanic origin, and American Indians, may be particularly disposed to renal disease as a complication of diabetes.

• #2 Pathogenesis of Diabetic Nephropathy – Chronic Kidney Disease and Type 2 Diabetes – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK571720/

  Our understanding of the natural history of diabetic nephropathy has emerged largely from patients with type 1 diabetes. However, histological manifestations among those with type 2 diabetes are similar. Both the clinical manifestations and the histological appearances of kidney disease associated with diabetes have been well characterized. The pathogenesis of diabetic nephropathy is initiated and maintained by four causal factors, which can be classified broadly into metabolic, hemodynamic, growth, and proinflammatory or profibrotic factors. These pathogenetic factors produce lesions in various kidney compartments: glomeruli, tubuli, interstitium, and vasculature. A complex series of molecules, receptors, enzymes, and transcription factors participate in the process that drives the earliest stages of kidney disease to an enlarged kidney with hypertrophy, expanded extracellular matrix (ECM), glomerulosclerosis, vascular hyalinosis, interstitial fibrosis and tubular atrophy, and loss of function culminating in end-stage renal disease (ESRD).

• #2 Pathophysiology of Diabetic Kidney Disease – European Medical Journal

  https://www.emjreviews.com/nephrology/article/pathophysiology-of-diabetic-kidney-disease-j120121/

  Diabetic kidney disease (DKD) has been an immense burden on the healthcare system, and is the leading cause of end stage kidney disease worldwide. […] DKD involves various intersecting pathways that lead to progressive kidney damage. […] Forty percent of patients with diabetes will have subsequent diabetic kidney disease (DKD). […] DKD damages the podocytes, glomeruli, and the tubules, as well as causing changes on the cellular level including mitochondrial injury and epigenetic changes. […] The end result of uncontrolled hyperglycaemia in the kidney is nephron death. […] The inception of the renal involvement in this disorder is the onset of uncontrolled levels of blood glucose. […] Hyperglycaemia leads to hyperfiltration, which is followed by metabolic, hormonal, haemodynamic, inflammatory and epigenetic changes.

• #2 Pathophysiology of Diabetic Kidney Disease – European Medical Journal

  https://www.emjreviews.com/nephrology/article/pathophysiology-of-diabetic-kidney-disease-j120121/

  Hyperglycaemia initiates its effects on the kidney by disturbing the osmotic forces. […] Measures taken to control hyperglycaemia have been proven to inhibit DKD progression, myocardial infarction, and mortality. […] Hyperglycaemia and SGLT2-assisted decreased distal sodium delivery leads to activation of RAAS, producing efferent arteriolar vasoconstriction and afferent vasodilation, and amplifying intraglomerular hypertension. […] Diabetes is associated with dysregulation of multiple metabolic pathways. […] Hyperglycaemia can lead to oxidative stress and hypoxia in multiple ways. […] Inflammation plays a vital role in the pathogenesis of DKD. […] Hyperglycaemia leads to higher levels of glycan and galactosamine-bound substances that are recognised by these receptors. […] Hyperglycaemia and its effects cause DNA damage, and display effects of ageing in patients with diabetes by causing chromosomal telomere shortening, resulting in proteinuria and DKD progression.

• #2 Diabetes and Renal Complications: An Overview on Pathophysiology, Biomarkers and Therapeutic Interventions

  https://www.mdpi.com/2227-9059/12/5/1098

  The overproduction of ROS due to hyperglycaemia stimulates the activation and recruitment of intracellular signalling molecules including cytokines, growth factors and transcription factors which drive the pathological pathways of renal inflammation and fibrosis. […] In DKD, inflammation plays an important role. It is driven by multiple pathways including oxidative stress, activation of transcription pathways such as JAK/STAT and transcription factors including nuclear factor κB (NF-κB) and the activation of pro-inflammatory cytokines. […] Renal fibrosis is recognised as a key hallmark in the progression of DKD, particularly in driving renal structural changes especially extracellular matrix (ECM) accumulation causing renal injury. […] Albuminuria is recognised as an early predictor for the progression of DKD. The variety of pathological mechanisms including oxidative stress, renal inflammation, fibrosis and haemodynamic alterations lead to the damage of the highly regulated glomerular filtration barrier, compromising the filtration process.

• #2 Diabetes and Renal Complications: An Overview on Pathophysiology, Biomarkers and Therapeutic Interventions

  https://www.mdpi.com/2227-9059/12/5/1098

  The pathophysiology of DKD is multifactorial in that the diabetes-induced hyperglycaemia drives various pathological pathways within the kidney which can be broadly characterised as haemodynamic, metabolic, inflammatory, fibrotic and oxidative stress as the major determinant of this pathological process. […] The key features of diabetes-mediated renal complications include morphological and functional alterations to renal glomeruli and tubules leading to mesangial expansion, glomerulosclerosis, homogenous thickening of the glomerular basement membrane (GBM), albuminuria, tubulointerstitial fibrosis and progressive decline in renal function. […] Chronic hyperglycaemia induces oxidative stress via enhanced reactive oxygen species (ROS) production and diminished antioxidant defence in DKD.

• #2 Diabetic Nephropathy: Symptoms, Outlook, and More

  https://www.healthline.com/health/type-2-diabetes/nephropathy

  Diabetic nephropathy is a type of progressive kidney disease that may occur in people who have diabetes. […] Over 40 percent of cases of kidney failure are caused by diabetes, and its estimated that approximately 180,000 people are living with kidney failure caused by complications of diabetes. Diabetes is also the most common cause of end-stage renal disease (ESRD). […] The exact reason this occurs in people with diabetes is unknown, but high blood sugar levels and high blood pressure are thought to contribute to diabetic nephropathy. […] Other factors have been shown to increase your risk of getting diabetic nephropathy, such as: being African-American, Hispanic, or American Indian; having a family history of kidney disease; developing type 1 diabetes before you are 20 years of age; smoking; being overweight or obese; having other diabetes complications, such as eye disease or nerve damage.

• #2 Diabetic Nephropathy: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/238946-overview

  It has been argued that the genetic predisposition to diabetes that is so frequent in Western societies, and even more so in minorities, reflects the fact that in the past, insulin resistance conferred a survival advantage (the so-called thrifty genotype hypothesis). […] Some evidence has accrued for a polymorphism in the gene for angiotensin-converting enzyme (ACE) in either predisposing to nephropathy or accelerating its course. […] A study by Bherwani et al suggested that an association exists between decreased serum folic acid levels and diabetic nephropathy.

• #2 Diabetic Nephropathy – Symptoms, Causes, Treatment & Prevention PACE Hospitals – Best Hospitals in Hitech City, Hyderabad, India | Near Madhapur, Kukatpally, KPHB, Kondapur, Gachibowli, Jubilee Hills, Banjara HillsPACE Hospitals Contact N

  https://www.pacehospital.com/diabetic-nephropathy-symptoms-causes-prevention-and-treatment

  Diabetes has the potential to harm body’s nerves which may make it difficult to urinate. A full bladder can cause pressure that builds up and damages the kidneys. High blood pressure is a common side effect of diabetes that can harm the kidneys. […] Various risk factors may influence the onset and progression of diabetic nephropathy, which can be classified into two categories, modifiable and non-modifiable risk factors. […] The longer a person has diabetes, the higher the risk of developing diabetic nephropathy. Patients with diabetes for over 10 years are at significantly increased risk. […] Advanced age is associated with a higher likelihood of diabetic nephropathy, independent of diabetes duration. […] Family history and certain genetic markers have been linked to an increased risk of diabetic nephropathy. Ethnic background also plays a role, with higher incidences observed in African American population.

• #2 Diabetic Nephropathy – a Review of Risk Factors, Progression, Mechanism, and Dietary Management

  https://www.biomolther.org/journal/view.html?uid=1312&vmd=Full&

  An early symptom of DN includes high excretion of albumin in urine, glomerular and renal hypertrophy, hyperfiltration, and mesangial expansion with ECM proteins aggregation such as fibronectin, laminin, and collagen. […] Risk factors were defined as two types for DN: modifiable and non-modifiable factors. Modifiable factors include hypertension, glycemic level management, and dyslipidemia. Additionally, smoking was demonstrated as an additional modifiable risk factor. Non-modifiable factors are race, age, gestation, genetic profile, and sex. Patients with a family history of DN were more susceptible to develop the condition. A race such as the American population of Mexicans, Africans, and Pima people of Native Americans showed higher rates of developing DN. […] Genes, such as ACE, APOC1, GREM1, UNC13B, ALR2, APOE, CARS, CPVL/CHN2, eNOS, EPO, FRMD3, HSPG2, and VEGF, are identified for the hereditary reasons of DN. High levels of HbA1C, proteinuria, systolic blood pressure, and habits increase the risk of DN in DM patients.

• #2 Diabetic Nephropathy: Symptoms, Causes, Diagnosis and treatment PACE Hospitals – Best Hospitals in Hitech City, Hyderabad, India | Near Madhapur, Kukatpally, KPHB, Kondapur, Gachibowli, Jubilee Hills, Banjara HillsPACE Hospitals Contact N

  https://www.pacehospital.com/diabetic-nephropathy

  Diabetic Nephropathy or Diabetic Kidney Disease is a type of kidney disease that occurs in some people who have diabetes. […] Leading cause of kidney disease is diabetes, 30 percent of patients with Type 1 diabetes and 10 to 40 percent of those with Type 2 diabetes suffer from Diabetic kidney disease. […] High blood sugar, can damage the blood vessels in your kidneys due to that they don’t work as well. Many people with diabetes also develop high blood pressure, which can also damage your kidneys. […] Your risk of Diabetic Kidney Disease is greater if you have type 1 or type 2 diabetes. Several other factors may increase your risk of Diabetic Kidney Disease that includes: Smoking, High blood pressure (hypertension), High cholesterol (hypercholesterolemia), High blood sugar (hyperglycemia), A family history of kidney disease and diabetes.

• #2 Diabetic Nephropathy – Symptoms, Causes, Treatment & Prevention PACE Hospitals – Best Hospitals in Hitech City, Hyderabad, India | Near Madhapur, Kukatpally, KPHB, Kondapur, Gachibowli, Jubilee Hills, Banjara HillsPACE Hospitals Contact N

  https://www.pacehospital.com/diabetic-nephropathy-symptoms-causes-prevention-and-treatment

  Elevated blood glucose levels are a primary risk factor. Maintaining optimal glycemic control is crucial to prevent kidney damage. […] High blood pressure significantly increases the risk of diabetic nephropathy. Effective management of blood pressure can help reduce the risk of progression from mild to severe kidney disease. […] Diabetes-related kidney damage can be more likely in those with elevated cholesterol and triglyceride levels. […] Smoking is one established risk factor for diabetic nephropathy. Giving up smoking can delay the onset of diabetic nephropathy and lower the incidence of microalbuminuria. […] Diabetic kidney disease (DKD) can be prevented or slowed down by addressing recognised risk factors along with the preventive strategies such as glycaemic control (maintaining optimum blood sugar levels).

• #2 Diabetic nephropathy (kidney disease) | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/diabetic-nephropathy-kidney-disease

  Diabetic nephropathy happens when diabetes damages blood vessels and other cells in the kidneys. […] Diabetic nephropathy is a common complication of type 1 and type 2 diabetes. […] Over time, diabetes that isn’t well controlled can damage blood vessels in the kidneys that filter waste from the blood. This can lead to kidney damage and cause high blood pressure. […] High blood pressure can cause more kidney damage by raising the pressure in the filtering system of the kidneys.

• #2 Diabetic Nephropathy – Genitourinary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/genitourinary-disorders/glomerular-disorders/diabetic-nephropathy

  Diabetic nephropathy is glomerular sclerosis and fibrosis caused by the metabolic and hemodynamic changes of diabetes mellitus. It manifests as slowly progressive albuminuria with worsening hypertension and chronic kidney disease. […] Diabetic nephropathy is the most common cause of nephrotic syndrome in adults. Diabetic nephropathy is also the most common cause of kidney failure worldwide, accounting for up to half of new cases in the United States. The lifetime prevalence of kidney failure is approximately 40% among patients with diabetes mellitus. […] Other risk factors include the following: Duration and degree of hyperglycemia, Hypertension, Dyslipidemia, Cigarette smoking, Certain polymorphisms affecting the renin-angiotensin-aldosterone axis, Family history of diabetic nephropathy, Genetic variables (decreased number of glomeruli).

• #2 Diabetes and Renal Complications: An Overview on Pathophysiology, Biomarkers and Therapeutic Interventions

  https://www.mdpi.com/2227-9059/12/5/1098

  Diabetic kidney disease (DKD) is a major microvascular complication of both type 1 and type 2 diabetes. DKD is characterised by injury to both glomerular and tubular compartments, leading to kidney dysfunction over time. It is one of the most common causes of chronic kidney disease (CKD) and end-stage renal disease (ESRD). Persistent high blood glucose levels can damage the small blood vessels in the kidneys, impairing their ability to filter waste and fluids from the blood effectively. Other factors like high blood pressure (hypertension), genetics, and lifestyle habits can also contribute to the development and progression of DKD. […] The key features of renal complications of diabetes include morphological and functional alterations to renal glomeruli and tubules leading to mesangial expansion, glomerulosclerosis, homogenous thickening of the glomerular basement membrane (GBM), albuminuria, tubulointerstitial fibrosis and progressive decline in renal function. In advanced stages, DKD may require treatments such as dialysis or kidney transplant to sustain life. Therefore, early detection and proactive management of diabetes and its complications are crucial in preventing DKD and preserving kidney function.

• #2 Diabetic Nephropathy – a Review of Risk Factors, Progression, Mechanism, and Dietary Management

  https://www.biomolther.org/journal/view.html?uid=1312&vmd=Full&

  The initial phase of DN starts with the glomerular basement membrane (GBM) thickening. Normal glomerular filtration rate (GFR), lack of albuminuria, and hypertension are often observed in this stage for five years from the onset of GBM thickening. The next stage involves the development of mild to severe mesangial expansion. […] Hyperglycemia is found to raise the level of glucose strained over the glomerular filtration in the proximal tube leading to glucose hyper-reabsorption. […] In hypertensive patients, DKD is also a significant reason for cardiovascular risk. Microalbuminuria acts as the first clinical expression of DKD and almost 50% of microalbuminuria patients will advance to macroalbuminuria without an early diagnosis. […] Good control of the HbA1c level can avoid progression to ESRD and it demonstrates the significance of hyperglycemia in the development of DKD in T1DM patients.

• #2 Diabetic nephropathy – Wikipedia

  https://en.wikipedia.org/wiki/Diabetic_nephropathy

  Diabetic nephropathy, also known as diabetic kidney disease, is the chronic loss of kidney function occurring in those with diabetes mellitus. Diabetic nephropathy is the leading cause of chronic kidney disease (CKD) and end-stage renal disease (ESRD) globally. […] Pathophysiologic abnormalities in diabetic nephropathy usually begin with long-standing poorly controlled blood glucose levels. […] The disease progression of diabetic nephropathy involves various clinical stages: hyperfiltration, microalbuminuria, macroalbuminuria, nephrotic proteinuria to progressive chronic kidney disease leading to end-stage renal disease (ESRD). […] The pathophysiology of diabetic nephropathy is thought to involve an interaction between hemodynamic and metabolic factors. […] Hemodynamic factors include an increase in systemic and intraglomerular pressure, as well as the over-activation of the RAAS.

• #2 Diabetic Kidney Disease: Diagnosis, Treatment, and Prevention | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0615/p751.html

  DKD classically progresses from microalbuminuria (30 to 300 mg per day) to macroalbuminuria (more than 300 mg per day) and affects 25% of patients within 10 years of a type 2 diabetes diagnosis. […] Identification of patients with microalbuminuria allows for timely initiation of treatment to prevent disease progression and to reduce the risk of ESRD. […] Hyperglycemia should be managed with a multifactorial approach, including weight loss, exercise, diet modification, and medication. […] Sodium-glucose cotransporter-2 inhibitors decrease rates of progression of renal disease and need for renal replacement therapy. […] Blood pressure (BP) control is critical to prevent and slow the progression of DKD. […] Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) delay and reduce the progression of DKD.

• #2 Azthena logo with the word Azthena

  https://www.news-medical.net/health/What-causes-Diabetic-Nephropathy-(Kidney-Disease).aspx

  In many diabetics, the kidneys slowly thicken and become progressively scarred over time. […] While the exact cause of DN remains unknown, several mechanisms have been postulated. These include, hyperglycemia, glycation products, and the activation of pro-inflammatory cytokines. Some studies believe that poor glycemic control and hyperglycemia causes hyper-filtration and kidney injury. […] Kidney damage is also more likely to occur in those who smoke, have high blood pressure, and have had type 1 diabetes before the second decade of life. […] Hypertension is believed to play a role in DN, because controlling this parameter has shown to decrease the progression of diabetics to DN. […] High blood pressure known to cause endothelial injury and dysregulation of the blood pressure at the level of the kidney is a contributing factor.

• #2 Diabetic nephropathy: How diabetes affects the kidneys

  https://www.diabinfo.de/en/living-with-diabetes/complications/kidneys.html

  A significant influencing factor for kidney damage associated with diabetes is blood sugar. […] High blood pressure can be both a trigger for kidney damage as well as a consequence. […] Elevated albumin excretion and loss of renal function are also independent risk factors for cardiovascular disease and death. […] Good blood sugar management and strict monitoring of blood pressure levels are the most important factors to prevent or delay the progression of diabetic kidney disease. […] High blood pressure increases the risk of further kidney damage and the onset of cardiovascular disease. […] The incidence of diabetic nephropathy is approximately 20 to 40 percent for people with diabetes.

• #2 Diabetic nephropathy – Wikipedia

  https://en.wikipedia.org/wiki/Diabetic_nephropathy

  Metabolic factors include the formation of advanced glycation end-products (AGEs), which have a central role in the pathophysiology of many of the complications of diabetes mellitus, including cardiovascular complications. […] Diabetic nephropathy is the most common cause of end-stage renal disease, which may require hemodialysis or even kidney transplantation. […] Diabetic nephropathy affects approximately a third of patients with type 1 and type 2 diabetes mellitus. Diabetic nephropathy is responsible for about a third of cases of ESRD worldwide, and an even larger fraction in the developed countries.

• #2 Diabetic Nephropathy (Kidney Disease) | University Hospitals

  https://www.uhhospitals.org/health-information/health-and-wellness-library/article/diseases-and-conditions/diabetic-nephropathy-kidney-disease

  Diabetic kidney disease (DKD) is kidney disease that is due to diabetes. It is also called diabetic nephropathy. Nephropathy means your kidneys aren’t working normally. […] Type 1 and type 2 diabetes are the most common causes of kidney disease. […] High blood sugar linked to diabetes damages the kidney in several different ways. Mainly, it damages the blood vessels that filter the blood to make urine. […] People with diabetes also often develop high blood pressure. This can also damage your kidneys. […] Diabetic kidney disease is kidney disease that is due to diabetes. […] Both type 1 and type 2 diabetes are the most common cause of kidney disease.

• #3 Diabetic Nephropathy – a Review of Risk Factors, Progression, Mechanism, and Dietary Management

  https://www.biomolther.org/journal/view.html?uid=1312&vmd=Full&

  Diabetic nephropathy (DN) is a major disorder of diabetes mellitus (DM) which ends up in chronic renal failure. People with DM are ten times more prone to end-stage kidney failure. The International Diabetes Federation (IDF) reports that 40% of diabetic people might develop final stage renal failure. Furthermore, diabetes and hypertension, either in combination or separately lead to about 80% of end-stage kidney failure. […] Microalbuminuria is the early evidence for detecting DN. About 20% of patients develop nephropathy from microalbuminuria within a decade and nearly 20% of patients reach end-stage kidney disease. On one hand, around 20% of T1DM patients suffer from end-stage kidney failure in just a decade, and 75% of patients in less than two decades as there is no treatment available to date. On the other hand, T2DM patients show evidence of microalbuminuria and nephropathy within a short period of DM diagnosis.

• #3 Pathophysiology of Diabetic Kidney Disease – European Medical Journal

  https://www.emjreviews.com/nephrology/article/pathophysiology-of-diabetic-kidney-disease-j120121/

  Diabetic kidney disease (DKD) has been an immense burden on the healthcare system, and is the leading cause of end stage kidney disease worldwide. […] DKD involves various intersecting pathways that lead to progressive kidney damage. […] Forty percent of patients with diabetes will have subsequent diabetic kidney disease (DKD). […] DKD damages the podocytes, glomeruli, and the tubules, as well as causing changes on the cellular level including mitochondrial injury and epigenetic changes. […] The end result of uncontrolled hyperglycaemia in the kidney is nephron death. […] The inception of the renal involvement in this disorder is the onset of uncontrolled levels of blood glucose. […] Hyperglycaemia leads to hyperfiltration, which is followed by metabolic, hormonal, haemodynamic, inflammatory and epigenetic changes.

• #3 Pathophysiology of Diabetic Kidney Disease – European Medical Journal

  https://www.emjreviews.com/nephrology/article/pathophysiology-of-diabetic-kidney-disease-j120121/

  Hyperglycaemia initiates its effects on the kidney by disturbing the osmotic forces. […] Measures taken to control hyperglycaemia have been proven to inhibit DKD progression, myocardial infarction, and mortality. […] Hyperglycaemia and SGLT2-assisted decreased distal sodium delivery leads to activation of RAAS, producing efferent arteriolar vasoconstriction and afferent vasodilation, and amplifying intraglomerular hypertension. […] Diabetes is associated with dysregulation of multiple metabolic pathways. […] Hyperglycaemia can lead to oxidative stress and hypoxia in multiple ways. […] Inflammation plays a vital role in the pathogenesis of DKD. […] Hyperglycaemia leads to higher levels of glycan and galactosamine-bound substances that are recognised by these receptors. […] Hyperglycaemia and its effects cause DNA damage, and display effects of ageing in patients with diabetes by causing chromosomal telomere shortening, resulting in proteinuria and DKD progression.

• #3 Pathophysiology of Diabetic Kidney Disease – European Medical Journal

  https://www.emjreviews.com/nephrology/article/pathophysiology-of-diabetic-kidney-disease-j120121/

  The kidneys in a diabetic environment undergo many changes, from initial renal enlargement to vasoconstriction, endothelial and tubular cell injury, to eventual renal fibrosis. […] The earliest changes in DKD are due to hyperfiltration in the glomerulus, causing thickening and stiffness of the glomerular basement membrane from sheer pressure and deposition of extracellular matrix. […] Podocyte injury has been shown to mimic diabetic changes even in absence of hyperglycaemia, which indicates that podocyte injury is the key in development of DKD. […] Hyperglycaemia is probably the instigator for all the downstream effects leading to DKD.

• #3 Diabetes and Renal Complications: An Overview on Pathophysiology, Biomarkers and Therapeutic Interventions

  https://www.mdpi.com/2227-9059/12/5/1098

  The overproduction of ROS due to hyperglycaemia stimulates the activation and recruitment of intracellular signalling molecules including cytokines, growth factors and transcription factors which drive the pathological pathways of renal inflammation and fibrosis. […] In DKD, inflammation plays an important role. It is driven by multiple pathways including oxidative stress, activation of transcription pathways such as JAK/STAT and transcription factors including nuclear factor κB (NF-κB) and the activation of pro-inflammatory cytokines. […] Renal fibrosis is recognised as a key hallmark in the progression of DKD, particularly in driving renal structural changes especially extracellular matrix (ECM) accumulation causing renal injury. […] Albuminuria is recognised as an early predictor for the progression of DKD. The variety of pathological mechanisms including oxidative stress, renal inflammation, fibrosis and haemodynamic alterations lead to the damage of the highly regulated glomerular filtration barrier, compromising the filtration process.

• #3 Diabetic Nephropathy – Symptoms, Causes, Treatment & Prevention PACE Hospitals – Best Hospitals in Hitech City, Hyderabad, India | Near Madhapur, Kukatpally, KPHB, Kondapur, Gachibowli, Jubilee Hills, Banjara HillsPACE Hospitals Contact N

  https://www.pacehospital.com/diabetic-nephropathy-symptoms-causes-prevention-and-treatment

  Diabetes has the potential to harm body’s nerves which may make it difficult to urinate. A full bladder can cause pressure that builds up and damages the kidneys. High blood pressure is a common side effect of diabetes that can harm the kidneys. […] Various risk factors may influence the onset and progression of diabetic nephropathy, which can be classified into two categories, modifiable and non-modifiable risk factors. […] The longer a person has diabetes, the higher the risk of developing diabetic nephropathy. Patients with diabetes for over 10 years are at significantly increased risk. […] Advanced age is associated with a higher likelihood of diabetic nephropathy, independent of diabetes duration. […] Family history and certain genetic markers have been linked to an increased risk of diabetic nephropathy. Ethnic background also plays a role, with higher incidences observed in African American population.

• #3 Diabetes and kidney disease: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000494.htm

  Kidney disease or kidney damage often occurs over time in people with diabetes. This type of kidney disease is called diabetic nephropathy. […] In people with diabetes, the nephrons slowly thicken and become scarred over time. The nephrons begin to leak, and protein (albumin) passes into the urine. This damage can happen years before any symptoms of kidney disease begin. Some people who have type 2 diabetes that develops slowly already have kidney damage when they are first diagnosed. […] Kidney damage is more likely if you: Have uncontrolled blood sugar (glucose), Are obese, Have high blood pressure, Have type 1 diabetes that began before you were 20 years old, Have family members who also have diabetes and kidney problems, Smoke, Are African American, Mexican American, or Native American. […] Diabetic kidney disease is a major cause of sickness and death in people with diabetes. It can lead to the need for dialysis or a kidney transplant.

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