Summary

• Symptoms, which may be absent until the disease is advanced, include fatigue, anorexia, and swelling of the extremities. Symptoms of retinopathy (impaired vision) and neuropathy (decreased or abnormal sensation in lower extremities) are common.
• Signs include hypertension, oedema, and findings of diabetic retinopathy and neuropathy. In clinical uraemia, nausea and vomiting, dysgeusia (altered taste), and hiccoughs supervene.
• Proteinuria is the characteristic laboratory finding. Azotaemia may develop as the disease advances.
• Treatment includes intensive control of hyperglycaemia and hypertension with ACE inhibitors, angiotensin-receptor blockers (ARBs), or other antihypertensives. Lipid reduction, low-protein diets, and smoking cessation may be beneficial.
• Complications include hypoglycaemia due to intensive treatment of hyperglycaemia, hyperkalaemia as an adverse effect of ACE inhibitors or ARBs, volume depletion due to diuresis, and inadequate protein/caloric intake leading to malnutrition. Some patients may reach end-stage renal failure, requiring dialysis.