Diabetes is a common cause of CKD and the prevalence of diabetic nephropathy is increasing. A question that sometimes arises in the clinic is when it is appropriate to biopsy a patient with a presumptive diagnosis of diabetic…
Last year, Matt wrote a great post detailing the preliminary results of a randomized, controlled trial that had been presented at the ASN in November. It was reported that the anti-inflammatory modulator, Bardoxolone, significantly increased eGFR, in a…
Peritoneal dialysis solutions containing glucose polymers are becoming more popular, particularly in patients on APD who tend to retain fluid during their daytime fills. The rationale for their use is that they lead to a reduced absorption of…
The Renin-Angiotensin system is a major mediator of progressive renal injury In CKD and drugs that target the RAS have been shown to slow the progression of glomerulosclerosis, tubulointerstitial fibrosis and proteinuria. However, the effects of even maximal…
A promising new class of oral hypoglycemic agents for type 2 diabetes, the SGLT inhibitors, are on the horizon. As they work on the kidney, and potentially have renal side effects, it may be helpful to review them….
Maintaining adequate glycemic control in patients with diabetic kidney disease can be a challenge. First, it is hypothesized that worsened glycemic control will lead to a greater tendency towards diabetic nephropathy. Second, individuals with more advanced CKD are…
In recent years, there has been the suggestion that thiazide diuretics–long considered a front-line therapy for hypertension based on the ALLHAT study and others–may increase the risk of diabetes. Subsequent retrospective analysis of other major historical cohorts by…
The thiazolidinediones (a.k.a. “the glitazones”) are widely used in the treatment of of hyperglycemia. Although they have their side effects (an increased risk of cardiac events according to some epidemiologic studies, plus the possibility of fluid overload or…
Saw a patient today in clinic who was s/p simultaneous pancreas-kidney transplant about 15 years ago. The kidney is hanging in there (Cr 2.5mg/dl) and the patient does not require insulin, so we have to consider the transplant…
Diabetic nephropathy characterizes a huge chunk of any nephrologist’s practice. Some of the issues to tackle with each visit are obvious–e.g., adequate glucose control, minimization of proteinuria, control of blood pressure–and generally much easier to talk about than…
