title: Diabetic Kidney Disease: A Syndrome Rather Than a Single Disease.
abstract: The term "diabetic kidney" has recently been proposed to encompass the various lesions, involving all kidney structures that characterize protean kidney damage in patients with diabetes. While glomerular diseases may follow the stepwise progression that was described several decades ago, the tenet that proteinuria identifies diabetic nephropathy is disputed today and should be limited to glomerular lesions. Improvements in glycemic control may have contributed to a decrease in the prevalence of glomerular lesions, initially described as hallmarks of diabetic nephropathy, and revealed other types of renal damage, mainly related to vasculature and interstitium, and these types usually present with little or no proteinuria. Whilst glomerular damage is the hallmark of microvascular lesions, ischemic nephropathies, renal infarction, and cholesterol emboli syndrome are the result of macrovascular involvement, and the presence of underlying renal damage sets the stage for acute infections and drug-induced kidney injuries. Impairment of the phagocytic response can cause severe and unusual forms of acute and chronic pyelonephritis. It is thus concluded that screening for albuminuria, which is useful for detecting "glomerular diabetic nephropathy", does not identify all potential nephropathies in diabetes patients. As diabetes is a risk factor for all forms of kidney disease, diagnosis in diabetic patients should include the same combination of biochemical, clinical, and imaging tests as employed in non-diabetic subjects, but with the specific consideration that chronic kidney disease (CKD) may develop more rapidly and severely in diabetic patients.
authors.affiliation: SS Nefrologia, SCDU Urologia, San Luigi Gonzaga Hospital, Department of Clinical and Biological Sciences, University of Torino, Italy.
authors.forename: Giorgina B
authors.initials: GB
authors.lastname: Piccoli
authors.affiliation: SCDU Endocrinologia, Diabetologia e Metabolismo, Citta della Salute e della Scienza Torino, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Grassi
authors.affiliation: SC Nefrologia, Brotzu Hospital, Cagliari, Italy.
authors.forename: Gianfranca
authors.initials: G
authors.lastname: Cabiddu
authors.affiliation: SS Nefrologia, SCDU Urologia, San Luigi Gonzaga Hospital, Department of Clinical and Biological Sciences, University of Torino, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Nazha
authors.affiliation: SS Nefrologia, SCDU Urologia, San Luigi Gonzaga Hospital, Department of Clinical and Biological Sciences, University of Torino, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Roggero
authors.affiliation: SS Nefrologia, SCDU Urologia, San Luigi Gonzaga Hospital, Department of Clinical and Biological Sciences, University of Torino, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Capizzi
authors.affiliation: SCDU Radiologia, san Luigi Gonzaga Hospital, Department of Oncology, University of Torino, Italy.
authors.forename: Agostino
authors.initials: A
authors.lastname: De Pascale
authors.affiliation: SCDU Radiologia, san Luigi Gonzaga Hospital, Department of Oncology, University of Torino, Italy.
authors.forename: Adriano M
authors.initials: AM
authors.lastname: Priola
authors.affiliation: SS Nefrologia, SCDU Urologia, San Luigi Gonzaga Hospital, Department of Clinical and Biological Sciences, University of Torino, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Di Vico
authors.affiliation: SC Nefrologia, Brotzu Hospital, Cagliari, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Maxia
authors.affiliation: SC Nefrologia, Brotzu Hospital, Cagliari, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Loi
authors.affiliation: SCD Anatomia Patologica, Brotzu Hospital, Cagliari, Italy.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Asunis
authors.affiliation: SC Nefrologia, Brotzu Hospital, Cagliari, Italy.
authors.forename: Antonello
authors.initials: A
authors.lastname: Pani
authors.affiliation: SCDU Radiologia, san Luigi Gonzaga Hospital, Department of Oncology, University of Torino, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Veltri
mesh_terms: D000419:Albuminuria / Q000503:physiopathology*; D003928:Diabetic Nephropathies / Q000503:physiopathology*; D018450:Disease Progression; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000503:physiopathology*; D013577:Syndrome