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Classification of CKD with diabetes. DKD diabetic kidney disease, NDKD non-DKD, ORG obesity-related glomerulopathy, ADPKD autosomal dominant polycystic kidney disease
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The natural history of typical and classical “diabetic nephropathy” has been described as high levels of albuminuria and subsequent renal function decline. However, recent decades, the cases, who show the reduced glomerular filtration rate (GFR) without the progression of albuminuria, has been increased. “Diabetic kidney disease (DKD)” is a concept...
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Citations
... The natural history of typical and classical "diabetic nephropathy" has been described as high levels of albuminuria and subsequent declined renal function. However, in recent decades, the diabetic cases, who show the reduced estimated glomerular filtration rate (eGFR) without the progression of albuminuria, have been increased [1], which may be explained by that diabetic kidney disease (DKD) includes hypertensive nephrosclerosis, aging, obesity, and atherosclerosis-related renal diseases, in addition to classical diabetic nephropathy. According to the American Diabetes Association (ADA) and Kidney Disease Improving Global Outcomes (KDIGO) guidelines, sodium-glucose co-transporter 2 inhibitors (SGLT2is) are now recommended the first-line agents for patients with type 2 diabetes, chronic kidney disease (CKD), and eGFR ≥ 20 mL/min/1.73 ...
Diabetic kidney disease (DKD) includes hypertensive nephrosclerosis, aging, obesity, and atherosclerosis-related renal diseases, in addition to classical diabetic nephropathy. Sodium-glucose co-transporter 2 inhibitors (SGLT2is) have been approved for diabetic and non-diabetic patients at risk of chronic kidney disease progression. As the main mechanism for SGLT2i-mediated improvement of renal function, the normalization of tubulo-glomerular feedback (TGF) has been proposed. Enhanced TGF and resulting glomerular hypertension are observed in diabetic patients, and SGLT2is normalize TGF, reducing the intraglomerular pressure, which may reduce albuminuria and improve renal function. A type 2 diabetic patient with DKD complicated with hypertensive nephrosclerosis, whose renal function was deteriorated by SGLT2i and improved by glucagon-like peptide-1 receptor agonists (GLP-1RAs), was presented. In patients with hypertensive nephrosclerosis such as this case, the normalization of TGF by SGLT2i may further reduce afferent arteriolar blood flow which may worsen glomerular ischemia, resulting in deterioration of renal function. GLP-1RAs have no effect on TGF and have multiple effects to improve vascular endothelial function, which may be associated with an improvement in renal function in this patient.
... 4 However, previous studies often define patients with DM with CKD as diabetic nephropathy or simply CKD, leading to underexplored medical perspectives on diabetes with other CKD subtypes. 5 Furthermore, it has been reported that up to one-third of patients with newly diagnosed diabetes already had kidney damage, implying that the effect of hyperglycemia on the occurrence of CKD may initiate before glucose levels reach the diagnostic threshold. 6 7 Nevertheless, the effect of non-diabetic hyperglycemia, namely prediabetes, remains largely unclear. ...
Introduction
Cohort evidence of the association of diabetes mellitus (DM) with chronic kidney disease (CKD) is limited. Previous studies often describe patients with kidney disease and diabetes as diabetic kidney disease (DKD) or CKD, ignoring other subtypes. The present study aimed to assess the prospective association of diabetes status (no diabetes, pre-diabetes, screened diabetes, previously diagnosed controlled/uncontrolled diabetes with/without antidiabetic treatment) and random plasma glucose (RPG) with CKD risk (including CKD subtypes) among Chinese adults.
Research design and methods
The present study included 472 545 participants from the China Kadoorie Biobank, using baseline information on diabetes and RPG. The incident CKD and its subtypes were collected through linkage with the national health insurance system during follow-up. Cox regression models were used to calculate the HR and 95% CI.
Results
During 11.8 years of mean follow-up, 5417 adults developed CKD. Screened plus previously diagnosed diabetes was positively associated with CKD (HR=4.52, 95% CI 4.23 to 4.83), DKD (HR=33.85, 95% CI 29.56 to 38.76), and glomerulonephritis (HR=1.66, 95% CI 1.40 to 1.97). In those with previously diagnosed diabetes, participants with uncontrolled diabetes represented higher risks of CKD, DKD, and glomerulonephritis compared with those with controlled RPG. The risk of DKD was found to rise in participants with pre-diabetes and increased with the elevated RPG level, even in those without diabetes.
Conclusions
Among Chinese adults, diabetes was positively associated with CKD, DKD, and glomerulonephritis. Screen-detected and uncontrolled DM had a high risk of CKD, and pre-diabetes was associated with a greater risk of DKD, highlighting the significance of lifelong glycemic management.
Various groups of factors play a role in the development of excessive body weight and obesity: genetic, environmental (nutrition, physical activity), pathological (metabolic and hormonal disturbances, alterations in body fat
amount and composition as well as in the secretion of adipocytokines, impaired regulation by hypothalamic centers controlling appetite and satiety), psychological (eating disorders, consumption of food as a response to stress
or depression) as well as other factors not yet clarified to date which are also likely to have a bearing.
The aim of the study was to determine and analyze the risk factors responsible for the occurrence of excessive
body weight in a representative population of high school pupils aged 16-19 in the town of Plovdiv.
Materials and methods: An observational cross-section study was carried out on a randomized sample of 633
pupils (343 boys and 290 girls) aged 16-19 (Table 1). The study involved an interview and anthropometric evaluation of the pupils based on relevant clinical measurements, followed by recording of the body composition indices
determined by a TANITA BC-420 bio-impedance analyzer. The categories of overweight and obesity were determined in relation to the body mass index (BMI) according to WHO criteria. An original questionnaire developed by
the authors included a number of indices related to the social and economic status, family and health status, dietary
regimen and physical activity of the study participants.
Results: Factors correlating significantly with BMI in both sexes: family history for diabetes mellitus, obesity,
arterial hypertension (in total and individually for each disease), body mass (kg and %), muscle mass (kg), muscle
mass (%) (inverse correlation), water content (kg), water content (%) (inverse correlation), impedance (inverse
correlation), metabolic age, basal metabolism, waist circumference (cm), hip circumference (cm), waist/hip ratio,
arterial blood pressure – systolic and diastolic, pulse rate, intentional low calorie diet in the last 3 months and daily
water consumption. Factors correlating significantly with BMI in boys only: age, weight at birth, family history for
thyroid pathology, attending a specific high school, physical activity (frequency and duration combined) (inverse
correlation), breakfast and alcohol consumption (inverse correlations). Factors correlating significantly with BMI in
girls only: presence of a concomitant disease such as menstrual disturbances and hirsutism.
Conclusion: The risk factors for overweight in adolescents in real life in our country must be analyzed in order
to determine the possibilities of their impact and the prevention of obesity with the development of complications
and the occurrence of associated diseases in adulthood
