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Perspectives

Renal disease in diabetes: when to investigate for causes other than diabetes

Richard J Macisaac, Elif I Ekinci, George Jerums, Karen M. Dwyer
Abstract
In patients with type 1 or type 2 diabetes and chronic kidney disease, a careful assessment is needed to identify nondiabetic kidney disease because some forms of this condition are treatable and remission is possible.
Key Points
  • The spectrum of diabetic kidney disease is much broader than the traditional proteinuric model described in the 1980s.
  • Up to 30% of patients with chronic kidney disease and type 2 diabetes have been reported to have nondiabetic kidney disease (NDKD).
  • It is important to identify such patients because some forms of NDKD are treatable, sometimes leading to remission.
  • Patients with diabetes and reduced kidney function are at risk of contrast-induced nephropathy.
  • Clues to support a diagnosis of NDKD include: early onset of proteinuria or a rapid decrease in glomerular filtration rate (GFR) with a short duration of diabetes; the presence of an active urine sediment; signs or symptoms of another systemic disease; the absence of retinopathy or a significant reduction in GFR after starting a renin-angiotensin system inhibiting agent; and small kidneys on an ultrasonogram.
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