Natural History and Diagnosis of Diabetic Kidney Disease

Diabetic kidney disease is still the leading cause of renal failure of those initiating renal replacement therapy or undergoing renal transplantation. Over the years, the term "diabetic kidney disease". (DKD) has evolved to include diabetic nephropathy, incipient nephropathy, and diabetic glomerulopathy. Once thought to be primarily a proteinuric disease process, DKD has now been shown to also be a progressive non-proteinuric chronic kidney disease. This chapter reviews the natural history of DKD in both type 1 and type 2 diabetics. It also highlights the risk factors and current methods of clinical diagnosis with their limitations. Lastly, the knowledge of the kidney as a metabolic organ is introduced and it is suggested that focusing on renal metabolism may provide insight into novel diagnostic and therapeutic advances.