[Update on Diabetic Nephropathy 2018]

Area of Science:

• Nephrology
• Endocrinology
• Cardiology

Background:

• Prevalence of elevated albuminuria in diabetic patients is declining.
• Prevalence of reduced estimated glomerular filtration rate (eGFR) is increasing.
• Improved blood pressure and glucose control are likely contributors to these trends.

Purpose of the Study:

• To review current trends and management strategies for diabetic nephropathy.
• To highlight advancements in risk prediction and therapeutic interventions.
• To discuss updated guidelines for hypertension management in diabetic patients.

Main Methods:

• Review of recent literature and clinical guidelines.
• Analysis of epidemiological trends in diabetic nephropathy.
• Evaluation of pharmacological interventions and their efficacy.

Main Results:

• Validated online calculators exist for predicting renal replacement therapy, cardiovascular events, and mortality.
• Clinical variables are more predictive of end-stage renal disease than histology.
• SGLT-2 inhibitors and GLP-1 analogues significantly reduce macro- and microvascular events.
• Specific eGFR thresholds apply for prescribing SGLT-2 inhibitors (>60 mL/min/1.73 m²), and GLP-1 analogues/metformin (>30 mL/min/1.73 m²).

Conclusions:

• Clinical factors are superior to histology for predicting end-stage renal disease.
• Emerging therapies like SGLT-2 inhibitors and GLP-1 analogues offer significant benefits.
• Hypertension management goals and guidelines have been updated, emphasizing individualized targets.