Non-Proteinuric Diabetic Kidney Disease: A Comprehensive Review

Area of Science:

• Nephrology
• Endocrinology
• Diabetology

Background:

• Diabetic kidney disease (DKD) is a major cause of chronic kidney disease (CKD) and end-stage renal disease (ESRD).
• Traditional DKD diagnosis relies on albuminuria (microalbuminuria or overt proteinuria).
• Emerging evidence shows DKD can progress without significant albuminuria.

Purpose of the Study:

• To review the emerging clinical entity of non-proteinuric DKD (NP-DKD).
• To highlight the limitations of albuminuria-based criteria in DKD diagnosis and management.
• To advocate for a more inclusive model of DKD pathogenesis, diagnosis, and therapy.

Main Methods:

• Comprehensive literature review focusing on NP-DKD.
• Analysis of current diagnostic criteria and their limitations.
• Synthesis of emerging data on DKD pathogenesis and clinical presentation.

Main Results:

• A significant subset of diabetic patients develop renal functional decline without albuminuria (NP-DKD).
• NP-DKD is characterized by reduced estimated glomerular filtration rate (eGFR) with normal urine albumin-to-creatinine ratio (UACR < 30 mg/g).
• Current diagnostic and therapeutic paradigms for DKD may not adequately address NP-DKD.

Conclusions:

• NP-DKD represents an important clinical phenotype requiring recognition.
• Diagnostic and therapeutic strategies for DKD must evolve beyond albuminuria-only markers.
• Further research is needed to understand NP-DKD pathogenesis and develop targeted treatments.