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Diabetic Kidney
Disease
October 2019 Update
Hussein Sheashaa, MD, FACP
Professor of Nephrology, Urology and Nephrology Center and Director of Medical E-
Learning Unit, Mansoura University, ESNT CME Chair and Executive Director of
ESNT- Virtual Academy: http://lms.mans.edu.eg/esnt/
Master class, 21 October, 2019
1. Epidemiology, presentation and trends
2. Pathology and biomarkers
3. Management
4. Closing
Outline
Kidney International Supplements (March 2019) 9, e1–e81
China Kidney Disease Network
(CK-NET)
Etiology of ESRD:
USRDS
Diabetes Care Publish Ahead of Print, published online June 20, 2019
DKD:
Albuminuric and Non-albumiuric
Diabetology International (2019) 10:180–182
CKD with Diabetes
DKD:
Pattern of eGFR Decline
Kidney International (2019) 95, 178–187
Ophthalmic Res, Published online: June 28, 2019
DKD:
Role of Fundus Examination
PLoS One. 2019 Jul 29;14(7):e0220506
DKD:
Role of Fundus Examination
1. Epidemiology, presentation and trends
2. Pathology and biomarkers
3. Management
4. Closing
Outline
Chronic Renal Disease, Second Edition, 2020, Chapter 19
Diabetic Nephropathy:
Overview
Would You Biopsy Or Not?
Case Scenario
Am J Kidney Dis. 2019 Jan 17. pii: S0272-6386(18)31102-8.
Chronic Renal Disease, Second Edition, 2020
Diabetic Nephropathy:
Overview
DM:
When To Do Biopsy?
Acta Diabetol 2019 Aug;56(8):939-946
DM:
When To Do Biopsy?
DKD in Japan:
Nonproteinuric (Biopsy)
Diabetes Care May 2019;42:891–902
JASN Published online September 05, 2019
2019
DKD Management:
Biomarkers?
DKD Progression:
Total Bilirubin
Renal survival rate
7.5 µmol/L = 0.44 mg/dL
Endocr Pract. 2019 Jun;25(6):554-561.
1. Epidemiology, presentation and trends
2. Pathology and biomarkers
3. Management
4. Closing
Outline
540 Pages
DKD Management:
At A Glance
Use RAAS Blockers for Primary
Prevention
Am J Kidney Dis. 2019 Jun;73(6):786-796
Obesity and
Diet
Adipo-Renal Axis:
Renal Compression
Nat Rev Nephrol. 2019 June;15(6):367-385.
Early Life Action
Diabetic Kidney Disease:
Prediabetes
Obesity Medicine, Accepted 22 May 2019
Kidney International (June 2019) 95, 1433–1442
DKD Progression:
Role of Diet
Kidney International (June 2019) 95, 1433–1442
DASH Diet
Nephrol Dial Transplant (June 2019) 34: 893–896
TMAO, trimethylamine-N-oxide.
Diet and CKD:
Vegetables in Focus
Target of Glycemic
Control
www.cjasn.org Vol 14 June, 2019
CJASN ePress. Published on April 17, 2019
DKD:
Hypoglycemia
Anti-hyperglycemic
Drugs
J Cell Physiol. May 2019; 234: 5786-5797
Anti-diabetic Drugs:
Effects on Albuminuria
DKD:
Use of Metformin
Diabetes Obes Metab.2019 May;21(5):1199-1208.
DKD:
Use of Metformin
Int Urol Nephrol. 2019 Jul;51(7):1229-1230.
N Engl J Med. 2019 Jun 13;380(24):2295-2306
SGLT2 Inhibitors:
CREDENCE Trial
Double-blind, randomized trial
DKD:
Renal Congestion Remedy
Kidney Blood Press Res August 2019;44:449–456
Lancet Diabetes Endocrinol. Published online September 5, 2019
SGLT2 Inhibitors for The
Prevention of Kidney Failure
eGFR of more than 30 ml/min per 1.73Nutritional evaluation of elderly? Use of these agents in patients with type 1 DM
Kidney International (July 2019) 96, 8–10
DKD:
Use of SGLT2I
Safety of SGLT2 Inhibitors
Expert Opin Drug Saf. 2019 Apr;18(4):295-311.
SGLT2 Inhibitors:
EDKA
Br J Anaesth. 2019 July;123(1):27-36.
13 randomized controlled trials
Exp Ther Med. 2019 July;18(1):342-351.
GLP1 RA:
Liraglutide
A/Cr
UAE
Cr
Exp Ther Med. 2019 Jul;18(1):342-351.
TGFB
TNFa
IL6
BMI
TC
TG
GLP1 RA:
Liraglutide
GLP1 RA:
PIONEER 5
Lancet Diabetes Endocrinol. 2019 Jul;7(7):515-527
Circulation. 2019 Apr 23;139(17):2022-2031
GLP1 RA/SGLT2I
Circulation. 2019 Apr 23;139(17):2022-2031
Broad Renal OutcomeRenal Outcome excluding
macroalbuminuria
GLP1 RA/SGLT2I
JAMA. 2019;321(1):69-79
Double-blind, placebo RCT 605 centers across 27 countries
Linagliptin and CV Outcome:
(CARMELINA Trial)
Diabetes, Obesity and Metabolism, Accepted 10 April 2019
DKD:
Class Effects
Medicina (Kaunas). 2019 Jun 11;55(6). pii: E268.
Antihyperglycemics in DKD:
Management Algorithm
Other Drugs
DKD:
SONAR Trial
Lancet. 2019 May 11;393(10184):1937-1947.
DKD:
Current and Novel Therapies
Nat Rev Nephrol. 2019 Feb;15(2):68-70.
DKD:
Anti-ASK1
Selective Inhibitor of Apoptosis signal-regulating kinase 1
JASN 2019 Oct;30(10):1980-1990.
RRT
Ren Fail. 2019 Nov;41(1):521-531
HD or PD
1. Epidemiology, presentation and trends
2. Pathology and biomarkers
3. Management
4. Closing
Outline
Holistic Approach
Lessons from Basic
Research: Autophagy
Dr. Samar Ahmed Mahmoud, MD Nephrology thesis, Mansoura University
March 10th, 2019
Mansoura UNC Stem Cell
Research Group

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  1. Since both retinopathy and nephropathy are major diabetic microvascular complications, we investigated whether severity of diabeticretinopathy (DR) has adverse effects on renal function and albuminuria in the patients with type 2 diabetes mellitus (DM). We screened 2,197 adult patients with type 2 DM who had undergone fundus exam between August 2006 and February 2014. Among them, 1,592 subjects with available serial renal function and albuminuria measurement were included in the analysis. DR status was classified as no DR, non-proliferative DR (NPDR), and proliferative DR (PDR). The risk of CKD progression was assessed according to DR severity. A total of 384 (24.1%) had NPDR and 202 (12.7%) had PDR at either eye. The mean follow-up period was 5.6±2.1 years. DR was associated with lower body mass index, lower plasma hemoglobin, lower serum albumin level, longer duration of DM, poorer control of blood sugar, lower estimated glomerular filtration rate (eGFR), and greater amount of albuminuria. Interestingly, baseline DR severity was associated with faster renal function decline and greater albuminuria progression. In multivariate analysis, NPDR had 2.9 times and PDR had 16.6 times higher risk for CKD progression. Our findings showed that baseline DR severity is a prognostic factor for future CKD progression in type 2 DM patients. Therefore, clinicians must evaluate DR severity at the first visit and closely monitor renal function and albuminuria in the subjects with severe DR.