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Diabetic kidney disease

Последний просмотренный: 4 Jun 2025
Last updated: 15 Jan 2025

Резюме

Definição

História e exame físico

Principais fatores diagnósticos

  • presence of risk factors
  • hypertension
  • signs of retinopathy
  • oedema
Detalhes completos

Outros fatores diagnósticos

  • poor vision
  • numbness of the lower extremities
  • pain of the lower extremities
  • constitutional symptoms (advanced disease)
  • foot changes
  • orthostatic hypotension
  • skin changes
  • muscular atrophy
  • pallor (as glomerular filtration rate declines)
  • bleeding tendency (advanced disease)
  • Kussmaul's respirations (advanced disease)
Detalhes completos

Fatores de risco

  • sustained hyperglycaemia
  • hypertension
  • family history of hypertension and/or kidney disease
  • obesity
  • smoking
  • physical inactivity
  • dyslipidaemia
  • high protein, fat, and sodium intake
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • urinalysis
  • urinary albumin to creatinine ratio (ACR)
  • serum creatinine with GFR estimation
  • kidney ultrasound
Detalhes completos

Investigações a serem consideradas

  • cystatin C with GFR estimation
  • albumin excretion rate (AER)
  • CT abdomen
  • magnetic resonance angiography (MRA)
  • Doppler ultrasound
  • kidney biopsy
Detalhes completos

Algoritmo de tratamento

CONTÍNUA

type 1 diabetes with nephropathy: not on dialysis

type 2 diabetes with nephropathy: not on dialysis

on peritoneal dialysis or haemodialysis

Colaboradores

Autores

David J. Leehey, MD, FACP
David J. Leehey

Professor of Medicine

Division of Nephrology

Loyola University Medical Center

Maywood

IL

Declarações

DJL declares that he has no competing interests. DJL is an author of references cited in this topic.

Irfan Moinuddin, MD
Irfan Moinuddin

Assistant Professor of Medicine

Southern Illinois University School of Medicine

Springfield

IL

Declarações

IM declares that he has no competing interests.

Revisores

Rajiv Agarwal, MD

Professor of Medicine

Department of Medicine

Division of Nephrology

Indiana University School of Medicine

Indianapolis

IN

Declarações

RA declares that he has no competing interests.

Merlin C. Thomas, PhD

Associate Professor

Baker IDI Heart and Diabetes Institute

Melbourne

Australia

Declarações

MCT has received honoraria for speaking and educational sessions conducted by Sanofi-Aventis, Servier, Boehringer-Ingleheim, Abbott, Amgen, and Jansen-Cilag.

Damian Fogarty, BSc, MD, FRCP

Consultant/Senior Lecturer in Renal Medicine

Belfast City Hospital and Queen's University Belfast

Belfast City Hospital

Belfast

Northern Ireland

UK

Declarações

DF has no share options, research support, or employment with pharmaceutical companies. He has received one-time speaking fees to cover his time preparing educational talks in the broad areas of diabetic nephropathy and chronic kidney disease, promoting early recognition and evidence-based or best practice management.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

American Diabetes Association. Standards of care in diabetes - 2024. Diabetes Care. 2024 Jan;47(suppl 1):S1-321.Texto completo

Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group. KDIGO 2022 clinical practice guideline for diabetes management in chronic kidney disease. Kidney Int. 2022 Nov;102(5s):S1-127.Texto completo  Resumo

de Boer IH, Khunti K, Sadusky T, et al. Diabetes management in chronic kidney disease: a consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO). Diabetes Care. 2022 Dec 1;45(12):3075-90.Texto completo  Resumo

Davies MJ, Aroda VR, Collins BS, et al. Management of hyperglycemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2022 Nov 1;45(11):2753-86.Texto completo  Resumo

Lo C, Toyama T, Wang Y, et al. Insulin and glucose-lowering agents for treating people with diabetes and chronic kidney disease. Cochrane Database Syst Rev. 2018 Sep 24;(9):CD011798.Texto completo  Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
  • Diabetic kidney disease images
  • Diagnósticos diferenciais

    • Non-diabetic kidney disease
    • Multiple myeloma
    • Renal tract obstruction
    Mais Diagnósticos diferenciais
  • Diretrizes

    • Standards of care in diabetes - 2024
    • Newer pharmacologic treatments in adults with type 2 diabetes
    Mais Diretrizes
  • Folhetos informativos para os pacientes

    Diabetes: What can I do to keep healthy?

    Chronic kidney disease: what is it?

    Mais Folhetos informativos para os pacientes
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