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Review
. Jan-Feb 2019;13(1):474-479.
doi: 10.1016/j.dsx.2018.11.014. Epub 2018 Nov 3.

Albuminuric and Non-Albuminuric Patterns of Chronic Kidney Disease in Type 2 Diabetes

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Review

Albuminuric and Non-Albuminuric Patterns of Chronic Kidney Disease in Type 2 Diabetes

Vadim V Klimontov et al. Diabetes Metab Syndr. .

Abstract

A growing body of evidence supports a shift in the natural history of chronic kidney disease (CKD) in subjects with diabetes. Specifically, normoalbuminuric chronic kidney disease (NA-CKD), which is characterized by a decline in the glomerular filtration rate in the absence of a preceding or accompanying elevation of albuminuria, has become a widely prevalent variant of renal impairment in diabetes. Diabetic women and nonsmoking individuals with better glycemic control have a better chance of preserving normoalbuminuria, even in the case of declining renal function. The wide use of renin-angiotensin system blockers, advances in antihyperglycemic, antihypertensive, and hypolipidemic therapy, and smoking cessation are suspected to be responsible for an increasing proportion of NA-CKD among diabetic subjects with renal impairment. Significant differences in the sets of risk factors, renal morphology, comorbidity, and outcomes were found between the albuminuric and normoalbuminuric CKD patterns. NA-CKD, even if a more favorable option in terms of the risk of end-stage renal disease, is clearly associated with cardiovascular disease and its risk factors. The presence of NA-CKD in patients with diabetes increases the risk of myocardial infarction, stroke, and cardiovascular death. The study of the molecular pathways, clinical course, and outcomes of NA-CKD in diabetic subjects and the search for more specific diagnostic and treatment options are challenges for future research.

Keywords: Albuminuria; Chronic kidney disease; Diabetes; Diabetic nephropathy; Glomerular filtration rate.

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