Normoalbuminuric diabetic kidney disease: a distinct entity?

Excerpt

Diabetic kidney disease (DKD) is the major cause of renal disease due to hyperglycemia. Worldwide, approximately 40% of people with diabetes develop DKD. Presence of persistent albuminuria in urine is the initial clinical indication of DKD. Of the major pathways known to be involved in the development and progression of DKD, the renin-angiotensin-aldosterone system (RAAS) has been considered as the most important pathway as it plays a central role in maintaining blood pressure, glomerular pressure, and fluid and electrolyte balance via angiotensin II. During development of diabetic nephropathy (DN), there is increased formation of angiotensin II, by the action of ACE, which further results in renal vascular constriction via activation of its receptor ATR1. However, activation of ATR2 ensues beneficial effects including vasodilation, antiinflammatory, and antiproliferative actions [1]. …