Diabetic Nephropathy

General Principles


Approximately 20%–40% of patients with either type of diabetes develop clinically evident diabetic nephropathy during their lifetime. Diabetic nephropathy is the leading cause of end-stage renal disease (ESRD) in the United States and a major cause of morbidity and mortality in patients with diabetes.

Risk Factors

Albuminuria is defined as an urinary albumin-to-creatinine ratio ≥30 mg/g. Poor glycemic control is the major risk factor for diabetic nephropathy, but hypertension and smoking are contributors. Obesity may contribute to kidney damage in T2DM.


Prevention of diabetic nephropathy starts at the time of diagnosis with achievement of glycemic, blood pressure, and lipid targets and smoking cessation. Patients with CKD are at higher risk for CVD and mortality, so management of other CV risk factors is particularly important.

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