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Diabetic nephropathy
What's new
Updated 2025 ADA guidelines for the diagnosis and management of diabetic nephropathy .
Background
Overview
Definition
DN is a chronic microvascular complication of diabetes characterized by glomerular hyperfiltration, progressive albuminuria, and reduced GFR.
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Pathophysiology
DN is caused due to hyperfiltration and reduction of GFR mainly due to hyperglycemia, systemic hypertension, and obesity.
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Disease course
Clinical manifestations of DN include microalbuminuria, macroalbuminuria, hyperglycemia, refractory hypertension, diabetic retinopathy, nephrotic or nephritic syndrome, anemia, bone and mineral metabolism complications. Disease progression may lead to CVD, infections, ESRD, and death.
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Prognosis and risk of recurrence
1-year mortality of patients on dialysis is around 21.5% in the US.
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Guidelines
Key sources
The following summarized guidelines for the evaluation and management of diabetic nephropathy are prepared by our editorial team based on guidelines from the American Diabetes Association (ADA 2025,2024), the Kidney Disease: Improving Global Outcomes Foundation (KDIGO 2024,2022), the European Society of Cardiology (ESC 2023), and the Canadian Cardiovascular Society (CCS 2022).
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