Diabetes and the kidney

Diabetic renal disease is the commonest cause of end-stage renal disease (ESRD) in the Western world and is rapidly becoming the leading cause in developing countries. The following chapters provide valuable insights into the epidemiology, pathophysiology, and pathology of diabetic renal disease with a focus on the clinical presentation, diagnosis, natural history, and progression of the disease. Many patients with diabetic renal disease suffer from microvascular and macrovascular complications of diabetes, including diabetic retinopathy, neuropathy, cardiovascular, and peripheral vascular disease. The authors discuss the available treatment approaches including lifestyle, diet, and exercise. In addition, they cover the importance of maintaining healthy blood pressure and glycaemic control to improve outcomes and the pharmacological treatments available. The authors describe the range of hypoglycaemic agents now available as well as insulin treatment. Ultimately, many patients will require management of complications of diabetes. Often they develop progressive renal impairment that requires renal replacement therapy with dialysis and transplantation, which are also discussed.