The commonest cause of chronic kidney disease and end-stage renal failure
Pathophysiology
Hyperglycaemia leads to ↑growth factors, renin-angiotensin-aldosterone activation, production of advanced glycosylation end-products, and oxidative stress
Causes ↑glomerular capillary pressure, podocyte damage, and endothelial dysfunction
Albuminuria is first clinical sign
Later scarring (glomerulosclerosis), nodule formation (Kimmelstiel-Wilson lesions), and fibrosis with progressive loss of renal function made worse by ↑BP
Diagnosis
Microalbuminuria; ACR 3–30mg/mmol (not detected on standard dipstick)
Management
Intensive BM control
Aim Hba1c of <53mmol/mol (<7%)- ↓microvascular complications
BP <130/80- for CV and renal protection
1st line: ACE-I or ARB for CV and renal protection