Non-Albuminuric Diabetic Kidney Disease
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Abstract
Diabetic kidney disease (DKD) is a major cause of end-stage kidney disease. The natural history of DKD, as proposed decades ago, mandated a period of albuminuria prior to glomerular filtration rate (GFR) decline, which has been challenged by recent findings. Non-albuminuric DKD, as the name implies, describes a phenotype of DKD in which impaired GFR occurs without significant albuminuria. Patients with non-albuminuric DKD exhibit different characteristics, such as a higher tendency in females, lower severity of associated comorbidities, well-controlled blood sugar, and a reduced rate of cardiovascular disease and mortality. These characteristics indicate a distinct pathogenesis, as supported by a growing body of evidence from biomarkers and histopathology. Nonetheless, no medication specifically designed for such a subgroup of patients exists. The principal treatment remains controlling risk factors for both kidney and cardiovascular disease.
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