Overview
Diabetic nephropathy (DN) describes a chronic reduction in kidney function associated with diabetes mellitus. It is characterised by proteinuria and a progressive reduction in the estimated glomerular filtration rate (eGFR). It generally occurs around 5-10 years after the onset of diabetes mellitus and can lead to chronic kidney disease (CKD).
Epidemiology
- Diabetes mellitus is the most common cause of CKD globally
- Around 20-40% of those with type 1 or type 2 diabetes mellitus develop DN
Investigations
Screening
Since the predominant feature in DN is proteinuria, and many patients may be asymptomatic, all patients with both type 1 or type 2 diabetes mellitus should be screened annually with a urinary albumin:creatinine ratio (ACR). An ACR ≥3 mg/mmol is considered clinically significant.
Management
- Optimise control of diabetes mellitus
- If ACR ≥3 mg/mmol: ACE inhibitor or angiotensin-II receptor blocker (ARB): slows progression
- If ACR ≥30 mg/mmol: ACE inhibitor/ARB and offer dapagliflozin if relevant eGFR thresholds are met
- Consider adding dapagliflozin to ACE inhibitor/ARB if ACR between 3-30 mg/mmol and relevant eGFR thresholds are met
