title: Diabetic kidney disease: from physiology to therapeutics.
abstract: Diabetic kidney disease (DKD) defines the functional, structural and clinical abnormalities of the kidneys that are caused by diabetes. This complication has become the single most frequent cause of end-stage renal disease. The pathophysiology of DKD comprises the interaction of both genetic and environmental determinants that trigger a complex network of pathophysiological events, which leads to the damage of the glomerular filtration barrier, a highly specialized structure formed by the fenestrated endothelium, the glomerular basement membrane and the epithelial podocytes, that permits a highly selective ultrafiltration of the blood plasma. DKD evolves gradually over years through five progressive stages. Briefly they are: reversible glomerular hyperfiltration, normal glomerular filtration and normoalbuminuria, normal glomerular filtration and microalbuminuria, macroalbuminuria, and renal failure. Approximately 20-40% of diabetic patients develop microalbuminuria within 10-15 years of the diagnosis of diabetes, and about 80-90% of those with microalbuminuria progress to more advanced stages. Thus, after 15-20 years, macroalbuminuria occurs approximately in 20-40% of patients, and around half of them will present renal insufficiency within 5 years. The screening and early diagnosis of DKD is based on the measurement of urinary albumin excretion and the detection of microalbuminuria, the first clinical sign of DKD. The management of DKD is based on the general recommendations in the treatment of patients with diabetes, including optimal glycaemic and blood pressure control, adequate lipid management and abolishing smoking, in addition to the lowering of albuminuria.
authors.affiliation: Research Unit, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain Sociedad Española de Nefrología & Red de Investigación Renal (RETIC/REDinREN/RD12/0021/0019, ISCIII), Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Mora-Fernández
authors.affiliation: Nephrology Service, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain.
authors.forename: Virginia
authors.initials: V
authors.lastname: Domínguez-Pimentel
authors.affiliation: Sociedad Española de Nefrología & Red de Investigación Renal (RETIC/REDinREN/RD12/0021/0019, ISCIII), Spain Clinical Analysis Service, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain.
authors.forename: Mercedes Muros
authors.initials: MM
authors.lastname: de Fuentes
authors.affiliation: Sociedad Española de Nefrología & Red de Investigación Renal (RETIC/REDinREN/RD12/0021/0019, ISCIII), Spain University Hospital Dr. Peset, Valencia, Spain.
authors.forename: José L
authors.initials: JL
authors.lastname: Górriz
authors.affiliation: Sociedad Española de Nefrología & Red de Investigación Renal (RETIC/REDinREN/RD12/0021/0019, ISCIII), Spain University Hospital of Bellvitge, Barcelona, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Martínez-Castelao
authors.affiliation: Research Unit, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain Sociedad Española de Nefrología & Red de Investigación Renal (RETIC/REDinREN/RD12/0021/0019, ISCIII), Spain Nephrology Service, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain jnavgon@gobiernodecanarias.org.
authors.forename: Juan F
authors.initials: JF
authors.lastname: Navarro-González
mesh_terms: D000419:Albuminuria / Q000175:diagnosis; D000818:Animals; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007668:Kidney / Q000378:metabolism / Q000503:physiopathology*