Phenotypes of diabetic kidney disease (literature review and own data)
This article provides up-to-date information about diabetic kidney disease (DKD), given its phenotypes. The literature data on the epidemiology, factors and mechanisms for the development of phenotypes of this complication in diabetes mellitus (DM), as well as the possibility of its diagnosis and treatment are presented. Variants of DKD course depending on the type of diabetes are described, based on our own researches. The analysis data are presented for 1,576 patients with type 1 and type 2 diabetes mellitus and latent autoimmune diabetes in adults, the distribution of patients according to the stages of CKD and phenotypes of DKD is described. According to laboratory and instrumental studies, non-albuminuric renal dysfunction is the dominant phenotype among patients with diabetes (60 % — with type 1 diabetes mellitus, 43 % — with type 2 diabetes mellitus, 53 % — with latent autoimmune diabetes in adults). The differences found depending on the type of DM are probably related to the difference in the mechanisms of kidney damage in various types of DM. Since type 2 DM is usually diagnosed long after manifestation, all pathogenetic links in the occurrence of DKD, including the phenomenon of glucose toxicity, endothelial dysfunction, oxidative stress, etc., lead to greater changes than in patients with type 1 DM, which is diagnosed immediately after the onset of the disease. Also, the frequency of the albuminuric form of DKD in type 2 DM is apparently related to the aggravating effects of hypertension, dyslipidemia, and insulin resistance, which cause the progression of DKD. A decrease in the prevalence of albuminuria phenotype is associated with both the improvement of the nephroprotective effect of hypoglycemic drugs, which allows us to stop the development of proteinuria and contributes to the regression of existing kidney damage, and with an increase in the number of patients having a decline in glomerular filtration rate without proteinuria. These data may be the result of earlier diagnosis of the underlying disease and its complications.
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