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Facing the Future: New Perspectives in Diabetes and Kidney Disease
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Facing the Future: New Perspectives in Diabetes and Kidney Disease

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Endocrinology & Metabolism".

Deadline for manuscript submissions: 27 November 2024 | Viewed by 49984

Special Issue Editors

Dr. José María Mora-Gutierrez

E-Mail Website
Guest Editor
Nephrology Department, Clínica Universidad de Navarra, Avenida Pio XII, 36. Pamplona, 31008 Navarra, Spain
Interests: diabetic kidney disease; functional renal magnetic resonance; cardiovascular disease; diabetic nephropathy; renin-angiotensin system; metalloproteinases; MMP-10; cardiorenal disease; bone mineral disease; hemodialysis
Dr. María José Soler

E-Mail Website
Guest Editor
1. Hospital Universitario Vall d’Hebron. Paseo Vall d’Hebron 119-129. 08035 Barcelona, Spain
2. Vall d’Hebron Institue of Research (VHIR). Edificio Mediterránea, Paseo Vall d’Hebron 119-129. 08035 Barcelona, Spain
3. Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, Spain
Interests: diabetic kidney disease; chronic kidney disease; cardiovascular disease; cardiorenal disease; acute kidney injury; diagnosis; prognosis; renin-angiotensin system; ACE2; onconephrology; diabetic nephropathy; kidney biopsy
Dr. Nuria Garcia-Fernandez

E-Mail Website
Guest Editor
1. Nephrology Department, Clínica Universidad de Navarra. Avenida Pio XII, 36. Pamplona 31008, Navarra, Spain
2. IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
3. Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, Spain
Interests: diabetic kidney disease; chronic kidney disease; cardiovascular disease; cardiorenal disease; hemodialysis; acute kidney injury; diagnosis; prognosis; functional renal magnetic resonance
Dr. Clara García-Carro

E-Mail Website
Guest Editor
1. Hospital Universitario Vall d’Hebron, Paseo Vall d’Hebron 119-129, 08035 Barcelona, Spain
2. Vall d’Hebron Institue of Research (VHIR), Edificio Mediterránea, Paseo Vall d’Hebron 119-129, 08035 Barcelona, Spain
Interests: diabetic kidney disease; diabetic nephropathy; chronic kidney disease; cardiovascular disease; cardiorenal disease; acute kidney injury; diagnosis; prognosis; onconephrology; kidney biopsy; inflammation; kidney transplantation; acute rejection; immnunotherapy

Special Issue Information

Dear Colleagues,

Diabetes mellitus is a growing disease worldwide. Diabetic kidney disease (DKD) is one of the most important complications of diabetes and the main cause of end-stage renal disease. DKD leads to an increase in the morbimortality of these patients mainly related to cardiovascular origin. Recently, a common microvascular mechanism for renal and cardiac damage has been recently proposed. This common pathway would be the same for all the other target organs and could explain the pathogenic processes behind the strong association between diabetic renal disease and cardiovascular disease. As mentioned, similar phenomena occur with other organs involved, such as the brain or the gastrointestinal tract. Hence, the importance of understanding kidney disease in diabetes from a new perspective and the challenge of new diagnostic and therapeutic tools to prevent the progression of kidney and heart dysfunction in diabetes.

Dr. José María Mora-Gutierrez
Dr. María José Soler
Dr. Nuria Garcia-Fernandez
Dr. Clara García-Carro
Guest Editors

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Keywords

  • Diabetes
  • Microvascular
  • Diabetic kidney disease
  • Cardiorenal disease
  • Cardiovascular disease
  • Brain
  • Gut-kidney axis
  • Biomarkers
  • Bioimage
  • Novel therapeutic targets

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Published Papers (13 papers)

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Research

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11 pages, 688 KiB  
Article
High Incidence of Adverse Outcomes in Haemodialysis Patients with Diabetes with or without Diabetic Foot Syndrome: A 5-Year Observational Study in Lleida, Spain
by Montserrat Dòria, Àngels Betriu, Montserrat Belart, Verónica Rosado, Marta Hernández, Felipe Sarro, Jordi Real, Esmeralda Castelblanco, Linda Roxana Pacheco, Elvira Fernández, Josep Franch-Nadal, Mònica Gratacòs and Dídac Mauricio
J. Clin. Med. 2021, 10(7), 1368; https://doi.org/10.3390/jcm10071368 - 26 Mar 2021
Cited by 3 | Viewed by 2044
Abstract
Background: We evaluated whether, in subjects receiving haemodialysis (HD), the presence of diabetic foot syndrome (DFS) was associated with increased mortality compared with subjects with diabetes mellitus (DM) without DFS and with non-diabetic subjects. Methods: Retrospective, observational study in 220 subjects followed for [...] Read more.
Background: We evaluated whether, in subjects receiving haemodialysis (HD), the presence of diabetic foot syndrome (DFS) was associated with increased mortality compared with subjects with diabetes mellitus (DM) without DFS and with non-diabetic subjects. Methods: Retrospective, observational study in 220 subjects followed for six years. We calculated and compared the frequency and 5-year cumulative incidence of all-cause mortality, cardiovascular (CV) mortality, CV events, major adverse CV events (MACE), and new foot ulcer (FU) or amputation. We also examined prognostic factors of all-cause and CV mortality based on baseline characteristics. Results: DM patients had a 1.98 times higher probability of all-cause mortality than those without DM (p = 0.001) and 2.42 times higher likelihood of CV mortality and new FU or amputation (p = 0.002 and p = 0.008, respectively). In the DM cohort, only the risk of a new FU or amputation was 2.69 times higher among those with previous DFS (p = 0.021). In patients with DM, older age was the only predictor of all-cause and CV mortality (p = 0.001 and p = 0.014, respectively). Conclusions: Although all-cause and CV mortality were increased on HD subjects with DM, the presence of DFS did not modify the excess risk. Additional studies are warranted to further explore the impact of DFS in subjects with DM undergoing HD. Full article
(This article belongs to the Special Issue Facing the Future: New Perspectives in Diabetes and Kidney Disease)
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14 pages, 1909 KiB  
Article
Melatonin Improves Mitochondrial Dynamics and Function in the Kidney of Zücker Diabetic Fatty Rats
by Ahmad Agil, Meriem Chayah, Lucia Visiedo, Miguel Navarro-Alarcon, José Manuel Rodríguez Ferrer, Mohamed Tassi, Russel J. Reiter and Gumersindo Fernández-Vázquez
J. Clin. Med. 2020, 9(9), 2916; https://doi.org/10.3390/jcm9092916 - 10 Sep 2020
Cited by 32 | Viewed by 3508
Abstract
Obesity and associated diabetes (diabesity) impair kidney mitochondrial dynamics by augmenting fission and diminishing fusion, which results in mitochondrial and renal dysfunction. Based on available evidence, the antioxidant activities of melatonin may improve impaired renal mitochondrial function in obese diabetic animals by restoring [...] Read more.
Obesity and associated diabetes (diabesity) impair kidney mitochondrial dynamics by augmenting fission and diminishing fusion, which results in mitochondrial and renal dysfunction. Based on available evidence, the antioxidant activities of melatonin may improve impaired renal mitochondrial function in obese diabetic animals by restoring the imbalanced dynamics through inhibiting fission and promoting fusion. Male Zücker diabetic fatty (ZDF) rats and lean littermates (ZL) were orally treated either with melatonin (10 mg/kg BW/day) (M-ZDF and M-ZL) or vehicle (C-ZDF and C-ZL) for 17 weeks. Kidney function was evaluated by measurement of total urine volume, proteinuria, creatinine clearance, and assessment of kidney mitochondrial dynamics and function. C-ZDF exhibited impaired dynamics and function of kidney mitochondria in comparison to C-ZL. Melatonin improved nephropathy of ZDF rats and modulated their mitochondrial dynamics by reducing expression of Drp1 fission marker and increasing that of fusion markers, Mfn2 and Opa1. Furthermore, melatonin ameliorated mitochondrial dysfunction by increasing respiratory control index and electron transfer chain complex IV activity. In addition, it lowered mitochondrial oxidative status. Our findings show that melatonin supplementation improves nephropathy likely via modulation of the mitochondrial fission/fusion balance and function in ZDF rats. Full article
(This article belongs to the Special Issue Facing the Future: New Perspectives in Diabetes and Kidney Disease)
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11 pages, 840 KiB  
Article
Burden of Undiagnosed Type 2 Diabetes in Diabetic Kidney Disease: A Japanese Retrospective Cohort Study
by Hayato Tanabe, Haruka Saito, Noritaka Machii, Akihiro Kudo, Kenichi Tanaka, Koichi Asahi, Junichiro James Kazama and Michio Shimabukuro
J. Clin. Med. 2020, 9(7), 2028; https://doi.org/10.3390/jcm9072028 - 28 Jun 2020
Cited by 4 | Viewed by 2849
Abstract
The risk of developing diabetic kidney disease (DKD) in patients with undiagnosed diabetes mellitus (UD) has never been evaluated. We studied the burden of UD on the risk of developing DKD in the Japanese population in a single-center retrospective cohort study. The patients [...] Read more.
The risk of developing diabetic kidney disease (DKD) in patients with undiagnosed diabetes mellitus (UD) has never been evaluated. We studied the burden of UD on the risk of developing DKD in the Japanese population in a single-center retrospective cohort study. The patients with type 2 diabetes mellitus, but without DKD (estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 or proteinuria), were recruited from January 2018 to January 2019; medical records were scrutinized retrospectively from January 2003 until May 2019. The individuals, with diabetes that could not be denied based on past and current records, comprised the undiagnosed diabetes (UD) group whereas those with confirmed diagnosis comprised the diagnosed diabetes (DD) group. The group differences were tested using a Kaplan–Meier curve and Cox proportional hazards model. Among the 408 participants, 164 (40.2%) and 244 (59.8%) comprised the DD and UD groups, respectively. The baseline parameters, including age, male gender, and BMI were comparable between the groups, but the plasma glucose, HbA1c levels, and diabetic retinopathy prevalence were higher in the UD group. The risk of developing DKD (log rank test, p < 0.001), an eGFR of < 60 mL/min/1.73 m2 (p = 0.001) and proteinuria (p = 0.007) were also higher in the UD group. The unadjusted and adjusted hazard ratios for DKD were 1.760 ((95% CI: 1.323–2.341), p < 0.001) and 1.566 ((95% CI: 1.159–2.115), p = 0.003), respectively, for the UD group. In conclusion, this is the first report showing that UD is a strong risk factor for DKD. The notion that a longer duration of untreated diabetes mellitus is involved strongly in the risk of developing DKD warrants the need for the identification and monitoring of UD patients. Full article
(This article belongs to the Special Issue Facing the Future: New Perspectives in Diabetes and Kidney Disease)
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Review

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13 pages, 302 KiB  
Review
GLP-1 Receptor Agonists in Diabetic Kidney Disease: From Physiology to Clinical Outcomes
by Alba Rojano Toimil and Andreea Ciudin
J. Clin. Med. 2021, 10(17), 3955; https://doi.org/10.3390/jcm10173955 - 31 Aug 2021
Cited by 9 | Viewed by 3940
Abstract
Diabetic kidney disease (DKD) is one of the most common complications in type 2 diabetes mellitus (T2D) and a major cause of morbidity and mortality in diabetes. Despite the widespread use of nephroprotective treatment of T2D, the incidence of DKD is increasing, and [...] Read more.
Diabetic kidney disease (DKD) is one of the most common complications in type 2 diabetes mellitus (T2D) and a major cause of morbidity and mortality in diabetes. Despite the widespread use of nephroprotective treatment of T2D, the incidence of DKD is increasing, and it is expected to become the fifth cause of death worldwide within 20 years. Previous studies have demonstrated that GLP-1 receptor agonists (GLP-1 RA) have improved macrovascular and microvascular outcomes independent of glycemic differences, including DKD. GLP-1Ras’ improvement on kidney physiology is mediated by natriuresis, reduction in hyperfiltration and renin-angiotensin-aldosterone system (RAAS) activity and anti-inflammatory properties. These findings translate into improved clinical outcomes such as an enhanced urine albumin-to-creatinine ratio (UACR) and a reduction in renal impairment and the need for renal replacement therapies (RRT). In this article, we review the role of GLP-1RAs on the mechanisms and effect in DKD and their clinical efficacy. Full article
(This article belongs to the Special Issue Facing the Future: New Perspectives in Diabetes and Kidney Disease)
22 pages, 822 KiB  
Review
Management of Kidney Failure in Patients with Diabetes Mellitus: What Are the Best Options?
by Juan M. Buades, Lourdes Craver, Maria Dolores Del Pino, Mario Prieto-Velasco, Juan C. Ruiz, Mercedes Salgueira, Patricia de Sequera and Nicanor Vega
J. Clin. Med. 2021, 10(13), 2943; https://doi.org/10.3390/jcm10132943 - 30 Jun 2021
Cited by 6 | Viewed by 5139
Abstract
Diabetic kidney disease (DKD) is the most frequent cause of kidney failure (KF). There are large variations in the incidence rates of kidney replacement therapy (KRT). Late referral to nephrology services has been associated with an increased risk of adverse outcomes. In many [...] Read more.
Diabetic kidney disease (DKD) is the most frequent cause of kidney failure (KF). There are large variations in the incidence rates of kidney replacement therapy (KRT). Late referral to nephrology services has been associated with an increased risk of adverse outcomes. In many countries, when patients reach severely reduced glomerular filtration rate (GFR), they are managed by multidisciplinary teams led by nephrologists. In these clinics, efforts will continue to halt chronic kidney disease (CKD) progression and to prevent cardiovascular mortality and morbidity. In patients with diabetes and severely reduced GFR and KF, treating hyperglycemia is a challenge, since some drugs are contraindicated and most of them require dose adjustments. Even more, a decision-making process will help in deciding whether the patient would prefer comprehensive conservative care or KRT. On many occasions, this decision will be conditioned by diabetes mellitus itself. Effective education should cover the necessary information for the patient and family to answer these questions: 1. Should I go for KRT or not? 2. If the answer is KRT, dialysis and/or transplantation? 3. Dialysis at home or in center? 4. If dialysis at home, peritoneal dialysis or home hemodialysis? 5. If transplantation is desired, discuss the options of whether the donation would be from a living or deceased donor. This review addresses the determinant factors with an impact on DKD, aiming to shed light on the specific needs that arise in the management and recommendations on how to achieve a comprehensive approach to the diabetic patient with chronic kidney disease. Full article
(This article belongs to the Special Issue Facing the Future: New Perspectives in Diabetes and Kidney Disease)
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15 pages, 332 KiB  
Review
Pathophysiological Implications of Imbalances in Fibroblast Growth Factor 23 in the Development of Diabetes
by Javier Donate-Correa, Ernesto Martín-Núñez, Ainhoa González-Luis, Carla M. Ferri, Desirée Luis-Rodríguez, Víctor G. Tagua, Carmen Mora-Fernández and Juan F. Navarro-González
J. Clin. Med. 2021, 10(12), 2583; https://doi.org/10.3390/jcm10122583 - 11 Jun 2021
Cited by 12 | Viewed by 2720
Abstract
Observational studies have associated the increase in fibroblast growth factor (FGF) 23 levels, the main regulator of phosphate levels, with the onset of diabetes. These studies open the debate on the plausible existence of undescribed diabetogenic mechanisms derived from chronic supraphysiological levels of [...] Read more.
Observational studies have associated the increase in fibroblast growth factor (FGF) 23 levels, the main regulator of phosphate levels, with the onset of diabetes. These studies open the debate on the plausible existence of undescribed diabetogenic mechanisms derived from chronic supraphysiological levels of FGF23, a prevalent condition in chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients. These maladaptive and diabetogenic responses to FGF23 may occur at different levels, including a direct effect on the pancreatic ß cells, and an indirect effect derived from the stimulation of the synthesis of pro-inflammatory factors. Both mechanisms could be mediated by the binding of FGF23 to noncanonical receptor complexes with the subsequent overactivation of signaling pathways that leads to harmful effects. The canonical binding of FGF23 to the receptor complex formed by the receptor FGFR1c and the coreceptor αKlotho activates Ras/MAPK/ERK signaling. However, supraphysiological concentrations of FGF23 favor non-αKlotho-dependent binding of this molecule to other FGFRs, which could generate an undesired overactivation of the PLCγ/CN/NFAT pathway, as observed in cardiomyocytes and hepatocytes. Moreover, the decrease in αKlotho expression may constitute a contributing factor to the appearance of these effects by promoting the nonspecific activation of the PLCγ/CN/NFAT to the detriment of the αKlotho-dependent Ras/MAPK/ERK pathway. The description of these mechanisms would allow the development of new therapeutic targets susceptible to be modified by dietary changes or by pharmacological intervention. Full article
(This article belongs to the Special Issue Facing the Future: New Perspectives in Diabetes and Kidney Disease)
13 pages, 805 KiB  
Review
How to Assess Diabetic Kidney Disease Progression? From Albuminuria to GFR
by Clara García-Carro, Ander Vergara, Sheila Bermejo, María A. Azancot, Ana I. Sánchez-Fructuoso, M. Dolores Sánchez de la Nieta, Irene Agraz and María José Soler
J. Clin. Med. 2021, 10(11), 2505; https://doi.org/10.3390/jcm10112505 - 5 Jun 2021
Cited by 23 | Viewed by 4710
Abstract
Diabetic kidney disease (DKD) is one of the most relevant complications of type 2 diabetes and dramatically increases the cardiovascular risk in these patients. Currently, DKD is severely infra-diagnosed, or its diagnosis is usually made at advanced stages of the disease. During the [...] Read more.
Diabetic kidney disease (DKD) is one of the most relevant complications of type 2 diabetes and dramatically increases the cardiovascular risk in these patients. Currently, DKD is severely infra-diagnosed, or its diagnosis is usually made at advanced stages of the disease. During the last decade, new drugs have demonstrated a beneficial effect in terms of cardiovascular and renal protection in type 2 diabetes, supporting the crucial role of an early DKD diagnosis to permit the use of new available therapeutic strategies. Moreover, cardiovascular and renal outcome trials, developed to study these new drugs, are based on diverse cardiovascular and renal simple and composite endpoints, which makes difficult their interpretation and the comparison between them. In this article, DKD diagnosis is reviewed, focusing on albuminuria and the recommendations for glomerular filtration rate measurement. Furthermore, cardiovascular and renal endpoints used in classical and recent cardiovascular outcome trials are assessed in a pragmatic way. Full article
(This article belongs to the Special Issue Facing the Future: New Perspectives in Diabetes and Kidney Disease)
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13 pages, 312 KiB  
Review
Obesity and Post-Transplant Diabetes Mellitus in Kidney Transplantation
by Paloma Leticia Martin-Moreno, Ho-Sik Shin and Anil Chandraker
J. Clin. Med. 2021, 10(11), 2497; https://doi.org/10.3390/jcm10112497 - 5 Jun 2021
Cited by 13 | Viewed by 4090
Abstract
Worldwide, the prevalence obesity, diabetes, and chronic kidney disease is increasing apace. The relationship between obesity and chronic kidney disease is multidimensional, especially when diabetes is also considered. The optimal treatment of patients with chronic kidney disease includes the need to consider weight [...] Read more.
Worldwide, the prevalence obesity, diabetes, and chronic kidney disease is increasing apace. The relationship between obesity and chronic kidney disease is multidimensional, especially when diabetes is also considered. The optimal treatment of patients with chronic kidney disease includes the need to consider weight loss as part of the treatment. The exact relationship between obesity and kidney function before and after transplantation is not as clear as previously imagined. Historically, patients with obesity had worse outcomes following kidney transplantation and weight loss before surgery was encouraged. However, recent studies have found less of a correlation between obesity and transplant outcomes. Transplantation itself is also a risk factor for developing diabetes, a condition known as post-transplant diabetes mellitus, and is related to the use of immunosuppressive medications and weight gain following transplantation. Newer classes of anti-diabetic medications, namely SGLT-2 inhibitors and GLP-1 agonists, are increasingly being recognized, not only for their ability to control diabetes, but also for their cardio and renoprotective effects. This article reviews the current state of knowledge on the management of obesity and post-transplant diabetes mellitus for kidney transplant patients. Full article
(This article belongs to the Special Issue Facing the Future: New Perspectives in Diabetes and Kidney Disease)
16 pages, 1921 KiB  
Review
Perspectives on the Role of Magnetic Resonance Imaging (MRI) for Noninvasive Evaluation of Diabetic Kidney Disease
by José María Mora-Gutiérrez, María A. Fernández-Seara, Rebeca Echeverria-Chasco and Nuria Garcia-Fernandez
J. Clin. Med. 2021, 10(11), 2461; https://doi.org/10.3390/jcm10112461 - 2 Jun 2021
Cited by 19 | Viewed by 3880
Abstract
Renal magnetic resonance imaging (MRI) techniques are currently in vogue, as they provide in vivo information on renal volume, function, metabolism, perfusion, oxygenation, and microstructural alterations, without the need for exogenous contrast media. New imaging biomarkers can be identified using these tools, which [...] Read more.
Renal magnetic resonance imaging (MRI) techniques are currently in vogue, as they provide in vivo information on renal volume, function, metabolism, perfusion, oxygenation, and microstructural alterations, without the need for exogenous contrast media. New imaging biomarkers can be identified using these tools, which represent a major advance in the understanding and study of the different pathologies affecting the kidney. Diabetic kidney disease (DKD) is one of the most important diseases worldwide due to its high prevalence and impact on public health. However, its multifactorial etiology poses a challenge for both basic and clinical research. Therefore, the use of novel renal MRI techniques is an attractive step forward in the comprehension of DKD, both in its pathogenesis and in its detection and surveillance in the clinical practice. This review article outlines the most promising MRI techniques in the study of DKD, with the purpose of stimulating their clinical translation as possible tools for the diagnosis, follow-up, and monitoring of the clinical impacts of new DKD treatments. Full article
(This article belongs to the Special Issue Facing the Future: New Perspectives in Diabetes and Kidney Disease)
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14 pages, 632 KiB  
Review
Diabetes, Albuminuria and the Kidney—Brain Axis
by Diana Maria Ariton, Joan Jiménez-Balado, Olga Maisterra, Francesc Pujadas, María José Soler and Pilar Delgado
J. Clin. Med. 2021, 10(11), 2364; https://doi.org/10.3390/jcm10112364 - 27 May 2021
Cited by 13 | Viewed by 3856
Abstract
Cognitive decline and kidney disease are significant public health problems that share similar characteristics and risk factors. The pathophysiology of the kidney–brain axis is not completely understood, and studies analysing the relationship between the biomarkers of kidney damage and cognitive impairment show different [...] Read more.
Cognitive decline and kidney disease are significant public health problems that share similar characteristics and risk factors. The pathophysiology of the kidney–brain axis is not completely understood, and studies analysing the relationship between the biomarkers of kidney damage and cognitive impairment show different results. This article focuses on the epidemiological and clinical aspects concerning the association of albuminuria, a marker for endothelial dysfunction and microvascular disease, and cognitive impairment in patients with chronic kidney disease, diabetic kidney disease and end-stage kidney disease. Most studies show a positive relationship between albuminuria and cognitive impairment in all groups, but evidence in type 2 diabetes (T2D) patients is limited. We briefly discuss the mechanisms underlying these associations, such as damage to the microvascular circulation, leading to hypoperfusion and blood pressure fluctuations, as well as increased inflammation and oxidative stress, both in the brain and in the kidneys. Further clinical and epidemiological studies developed to understand the interplay between the kidneys and brain diseases will hopefully lead to a reduction in cognitive impairment in these patients. Full article
(This article belongs to the Special Issue Facing the Future: New Perspectives in Diabetes and Kidney Disease)
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20 pages, 358 KiB  
Review
Urinary Extracellular Vesicles for Diabetic Kidney Disease Diagnosis
by Goren Saenz-Pipaon, Saioa Echeverria, Josune Orbe and Carmen Roncal
J. Clin. Med. 2021, 10(10), 2046; https://doi.org/10.3390/jcm10102046 - 11 May 2021
Cited by 14 | Viewed by 2804
Abstract
Diabetic kidney disease (DKD) is the leading cause of end stage renal disease (ESRD) in developed countries, affecting more than 40% of diabetes mellitus (DM) patients. DKD pathogenesis is multifactorial leading to a clinical presentation characterized by proteinuria, hypertension, and a gradual reduction [...] Read more.
Diabetic kidney disease (DKD) is the leading cause of end stage renal disease (ESRD) in developed countries, affecting more than 40% of diabetes mellitus (DM) patients. DKD pathogenesis is multifactorial leading to a clinical presentation characterized by proteinuria, hypertension, and a gradual reduction in kidney function, accompanied by a high incidence of cardiovascular (CV) events and mortality. Unlike other diabetes-related complications, DKD prevalence has failed to decline over the past 30 years, becoming a growing socioeconomic burden. Treatments controlling glucose levels, albuminuria and blood pressure may slow down DKD evolution and reduce CV events, but are not able to completely halt its progression. Moreover, one in five patients with diabetes develop DKD in the absence of albuminuria, and in others nephropathy goes unrecognized at the time of diagnosis, urging to find novel noninvasive and more precise early diagnosis and prognosis biomarkers and therapeutic targets for these patient subgroups. Extracellular vesicles (EVs), especially urinary (u)EVs, have emerged as an alternative for this purpose, as changes in their numbers and composition have been reported in clinical conditions involving DM and renal diseases. In this review, we will summarize the current knowledge on the role of (u)EVs in DKD. Full article
(This article belongs to the Special Issue Facing the Future: New Perspectives in Diabetes and Kidney Disease)
15 pages, 2190 KiB  
Review
Diabetic Kidney Disease, Cardiovascular Disease and Non-Alcoholic Fatty Liver Disease: A New Triumvirate?
by Carolina M. Perdomo, Nuria Garcia-Fernandez and Javier Escalada
J. Clin. Med. 2021, 10(9), 2040; https://doi.org/10.3390/jcm10092040 - 10 May 2021
Cited by 9 | Viewed by 3915
Abstract
Non-alcoholic fatty liver disease is a highly prevalent disease worldwide with a renowned relation to cardiovascular disease and chronic kidney disease. These diseases share a common pathophysiology including insulin resistance, oxidative stress, chronic inflammation, dysbiosis and genetic susceptibilities. Non-alcoholic fatty liver disease is [...] Read more.
Non-alcoholic fatty liver disease is a highly prevalent disease worldwide with a renowned relation to cardiovascular disease and chronic kidney disease. These diseases share a common pathophysiology including insulin resistance, oxidative stress, chronic inflammation, dysbiosis and genetic susceptibilities. Non-alcoholic fatty liver disease is especially prevalent and more severe in type 2 diabetes. Patients with non-alcoholic fatty liver disease should have liver fibrosis assessment in order to identify those at the highest risk of adverse outcomes so that appropriate management strategies can be implemented. Early diagnosis and treatment of non-alcoholic fatty liver disease could ameliorate the burden of cardiovascular disease and chronic kidney disease. Full article
(This article belongs to the Special Issue Facing the Future: New Perspectives in Diabetes and Kidney Disease)
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9 pages, 1088 KiB  
Review
Glomerular Diseases in Diabetic Patients: Implications for Diagnosis and Management
by Nestor Oliva-Damaso, José María Mora-Gutiérrez and Andrew S. Bomback
J. Clin. Med. 2021, 10(9), 1855; https://doi.org/10.3390/jcm10091855 - 24 Apr 2021
Cited by 8 | Viewed by 4943
Abstract
The prevalence of diabetes continues to rise worldwide. In addition to rising rates of diabetic kidney disease, we are also seeing a parallel rise in nondiabetic kidney disease among patients with diabetes. These nondiabetic lesions include focal segmental glomerulosclerosis, IgA nephropathy, membranous nephropathy, [...] Read more.
The prevalence of diabetes continues to rise worldwide. In addition to rising rates of diabetic kidney disease, we are also seeing a parallel rise in nondiabetic kidney disease among patients with diabetes. These nondiabetic lesions include focal segmental glomerulosclerosis, IgA nephropathy, membranous nephropathy, and other glomerular diseases. The management of diabetic kidney disease is rapidly evolving to include, beyond glycemic control and renin angiotensin inhibition, the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors and mineralocorticoid receptor antagonists. These and other new treatment strategies should be applicable to managing glomerular disease in diabetic patients to reduce toxicities associated with immunosuppression and, in particular, corticosteroids. The prevalence of glomerular disease in diabetic patients is underappreciated. Diagnosis and appropriately treating these diseases remain an important avenue to modify kidney outcomes in diabetic patients. Full article
(This article belongs to the Special Issue Facing the Future: New Perspectives in Diabetes and Kidney Disease)
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