Title: Diabetic kidney disease: Challenges, advances, and opportunities

Biography:

Sherif Mohamed Saleh is working as an Assistant Lecturer of Internal Medicine at the College of Dentistry in Pharos University in Alexandria, Egypt.

Abstract

Background: Diabetic kidney disease (DKD) is the most com-mon cause of the end-stage renal disease (ESRD). Regardless of intensive treatments with hyperglycemic control, blood pressure control, and the use of renin-angiotensin system blockades, the prevalence of DKD remains high. Recent stud- ies suggest that the spectrum of DKD has been changed and many progresses have been made to develop new treat-ments for DKD. Therefore, it is time to perform a systemic review on the new developments in the field of DKD.
Summary: Although the classic clinical presentation of DKD is characterized by a slow progression from microalbuminuria to macroalbuminuria and by a hyperfiltration at the early stage and progressive decline of renal function at the late stage, recent epidemiological studies suggest that DKD pa-tients have a variety of clinical presentations and progres-sion rates to ESRD. Some DKD patients have a decline in renal function without albuminuria but display prominent vascu-lar and interstitial fibrosis on renal histology. DKD patients are more susceptible to acute kidney injury, which might contribute to the interstitial fibrosis. A large portion of type 2 diabetic patients with albuminuria could have overlapping nondiabetic glomerular disease, and therefore, kidney biopsy is required for differential diagnosis for these patients. Only a small portion of DKD patients eventually progress to end-stage renal failure. However, we do not have sensitive and specific biomarkers to identify these high-risk patients. Genetic factors that have a strong association with DKD pro- gression have not been identified yet. A combination of cir-culating tumor necrosis factor receptor (TNFR)1, TNFR2, and kidney injury molecular 1 provides predictive value for DKD progression. Artificial intelligence could enhance the predic- tive values for DKD progression by combining the clinical parameters and biological markers. Sodium-glucose co- transporter-2 inhibitors should be added to the new stan- dard care of DKD patients.

Key Messages: Over last years, our under- standing of DKD has been much improved and new treatments to halt the progression of DKD are coming. However, better diagnostic tools, predictive markers, and treatment options are still urgently needed to help us to manage better.