Diabetic Kidney Disease: Challenges, Progress, and Possibilities

Clin J Am Soc Nephrol. 2017 Dec 7;12(12):2032-2045. doi: 10.2215/CJN.11491116. Epub 2017 May 18.


Diabetic kidney disease develops in approximately 40% of patients who are diabetic and is the leading cause of CKD worldwide. Although ESRD may be the most recognizable consequence of diabetic kidney disease, the majority of patients actually die from cardiovascular diseases and infections before needing kidney replacement therapy. The natural history of diabetic kidney disease includes glomerular hyperfiltration, progressive albuminuria, declining GFR, and ultimately, ESRD. Metabolic changes associated with diabetes lead to glomerular hypertrophy, glomerulosclerosis, and tubulointerstitial inflammation and fibrosis. Despite current therapies, there is large residual risk of diabetic kidney disease onset and progression. Therefore, widespread innovation is urgently needed to improve health outcomes for patients with diabetic kidney disease. Achieving this goal will require characterization of new biomarkers, designing clinical trials that evaluate clinically pertinent end points, and development of therapeutic agents targeting kidney-specific disease mechanisms (e.g., glomerular hyperfiltration, inflammation, and fibrosis). Additionally, greater attention to dissemination and implementation of best practices is needed in both clinical and community settings.

Keywords: altered renal hemodynamics; diabetic nephropathy; diagnosis; natural history; novel therapies; pathogenesis; structural changes.

MeSH terms

  • Diabetic Nephropathies / etiology
  • Diabetic Nephropathies / pathology*
  • Diabetic Nephropathies / physiopathology
  • Diabetic Nephropathies / therapy*
  • Disease Progression
  • Glomerular Filtration Rate
  • Humans
  • Hyperglycemia / complications
  • Hyperglycemia / therapy
  • Hypertension / complications
  • Hypertension / drug therapy
  • Hypoglycemic Agents / therapeutic use
  • Kidney Failure, Chronic / etiology*
  • Risk Factors


  • Hypoglycemic Agents