Why do diabetics develop Chronic kidney disease?
Diabetic nephropathy is the leading cause of ESKD in the industrialized world, and its incidence continues to increase.
Clinically it manifests as albuminuria and progressive loss of kidney function. The structural manifestations are:
• Glomerular basement membrane thickening
• Tubular basement membrane thickening
• Expansion of the mesangium at times forming nodules called Kimmelstiel-Wilson lesions
• Arteriolar hyalinosis
• Tubulointerstitial fibrosis
The pathophysiology of Chronic kidney disease in diabetics is complex and involves a combination of glucose toxicity, glomerular hypertension, oxidative stress, toxic effects of other metabolites, cytokines, and growth factors including advanced glycation end-products and transforming growth factor-beta, combined with poorly defined genetic risk factors.
