Diabetes nephropathy

Diabetic nephropathy 

Updated: 01/21/2021

© Jun Wang, MD, PhD

General features
  • Leading cause of end stage renal disease
  • Associated with increased extracellular matrix
  • Associated with long standing hyperglycemia
  • Renal disease reduced by tight diabetic control
  • Severity associated with diabetes duration, glycemic control, and genetic background
  • Earliest sign: moderately increased albuminuria (30-300 mg/d)
  • Annual glomerular filtration and urine ablumin level tests in diabetic patients for early detection
  • Diagnosis based on renal biopsy
Clinical features
  • Albuminuria
    • Moderately increased albuminuria (microalbuminuria): 30-300 mg/d
    • Severely increased albuminuria (macroalbuminuria): > 300 mg/d
  • Decreasing glomerular filtration rate
  • Hypertension
  • Hypoalbuminemia and associated presentations, such as edema
  • Less common, hematuria
  • Other diabetic complications: diabetic retinopathy, diabetic neuropathy, etc
Key pathogenesis
  • Excess extracellular matrix
  • Resulted from stromal cell proliferation caused by advanced glycation end products, etc
Pathological features
  • Glomerular abnormalities: Most common
Nodular glomerulosclerosis
Diffuse capillary basement membrane thickening
Diffuse and nodular glomerulosclerosis
Diffuse mesangial sclerosis
  • Macrovascular abnormalities: Atherosclerosis and ateriolosclerosis
  • Pyelonephritis: Tubular atrophy, interstitial fibrosis and inflammation





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