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Cardio Diabetes Medicine 2017 279

Diabetic Kidney Disease: When To Refer To A

Nephrologist & Why?

Dr. Pritam Gupta,MD
(HOD Med Sunder Lal Jain Hospital & Sr. Consultant Fortis Hospital,
Shalimar Bagh, Delhi)

Dr. Mudit Gupta, DM (Nephro),
Sr.Consultant Sunder Lal Jain Hospital & Sant Parmanand Hospital,Delhi

Introduction: M.K. Mani from Chennai done in a Hamlet of rural
The incidence and prevalence of diabetes mellitus population covering 21,062 subjects detected diabe-
(DM) continue to grow markedly throughout the tes in 3.64% and CKD up to stage III in 0.68% popula-

world, primarily due to the increase in T2DM. Because tion. SEEK study which was started in 2006, covering
of better available treatment options, proportion of 21 centers with 53 community camps to include rural,
diabetic individuals who develop chronic kidney semi-rural, semi-urban and urban communities from
disease (CKD) have reduced significantly. Although widely spread over in India, reported diabetes as a
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chronic kidney disease attributable to diabetes is re- main cause of CKD.
ferred to as DKD, but people with diabetes may have
other etiologies of CKD. Therefore DKD is defined as Diabetic Kidney disease (DKD)
a microvascular complication of diabetes marked by The term “diabetic kidney” has recently been pro-
albuminuria and a deteriorating course from normal posed to encompass the various lesions, involving
renal function to ESRD. Notably, DKD remains one of all kidney structures that characterize protean kidney
the most frequent complications of both types of dia- damage in patients with diabetes. The classic term
betes, and diabetes is the leading cause of end-stage “diabetic nephropathy” points to the presence of a
renal disease (ESRD), accounting for approximately single, well defined, and identifiable kidney disease.
50% of cases in the developed world. 2 Because of the complexity and heterogeneity of re-
nal impairment in diabetic patients, the classic term
Epidemiology: has been increasingly replaced by the more generic
Globally, an estimated 422 million adults were suf- term “diabetic kidney disease” which is reminiscent
fering from diabetes in 2014. The global prevalence of the term “chronic kidney disease”.
of diabetes has nearly doubled since 1980, rising
from 4.7% to 8.5%. This reflects an increase in asso- Non Diabetic Kidney disease (NDKD)
ciated risk factors such as obesity, dyslipidemia,and Type 2 DM often experience diabetic nephropathy
smoking. Diabetes is fastly gaining the status of a which is now referred as Diabetic kidney disease but
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potential epidemic in India with more than 62 million they can also develop other renal diseases, patholog-
diabetic individuals and is being considered as the ically unrelated to diabetes and are known as non-di-

capital of diabetes in the world. By 2030, it is predict- abetic Kidney disease (NDKD).The clinical clues for
ed that diabetes mellitus may afflict up to 79.4 million NDKD in Type 2 DM patients are (i) Short duration of
individuals in India. Diabetes is the leading cause of diabetes, (ii) Rapid loss of renal function, (iii) Heavy
ESRD affecting 25% to 40% of patients with T1DM and proteinuria with normal renal function, (iv) Significant
5% to 40% of patients with T2DM.The Chennai urban renal dysfunction with minimal/ normoalbuminuria,
Rural Epidemiological study (CURES – part I 2003) (v) Active urinary sediment, (vi) Gross hematuria and
conducted by V. Mohan which covered 50,000 sub- (vii) Absence of retinopathy. Renal biopsy is often re-
jects revealed that 16% of the subject above the age quired for precise diagnosis of NDKD.
of 20 Years were affected by Diabetes. A study of
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