Diabetic kidney disease: Manifestations, evaluation, and diagnosis - UpToDate

Diabetes is the leading cause of chronic kidney disease (CKD) and end-stage kidney disease (ESKD) in the United States and worldwide. While the gold standard for diagnosis of diabetic kidney disease is defined by histology of the kidney, the majority of patients do not undergo kidney biopsy and are presumed to have diabetic kidney disease based on clinical history and laboratory evaluation. This clinical practice is based in part on the desire to avoid an invasive procedure that may not alter treatment, as well as the misconception that there is a uniform clinical disease presentation, a traditional belief based on observational studies performed several decades ago. However, diabetic kidney disease is now known to be clinically and pathologically heterogeneous, and with the movement toward precision medicine, the terminology "diabetes and chronic kidney disease" is commonly used unless there is a histologic confirmation of diabetic glomerulopathy, tubulointerstitial changes, or arteri

Diabetes is the leading cause of chronic kidney disease (CKD) and end-stage kidney disease (ESKD) in the United States and worldwide. While the gold standard for diagnosis of diabetic kidney disease is defined by histology of the kidney, the majority of patients do not undergo kidney biopsy and are presumed to have diabetic kidney disease based on clinical history and laboratory evaluation. This clinical practice is based in part on the desire to avoid an invasive procedure that may not alter treatment, as well as the misconception that there is a uniform clinical disease presentation, a tradi