Opinion Review
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Oct 15, 2023; 14(10): 1450-1462
Published online Oct 15, 2023. doi: 10.4239/wjd.v14.i10.1450
Multifaceted relationship between diabetes and kidney diseases: Beyond diabetes
Pasquale Esposito, Daniela Picciotto, Francesca Cappadona, Francesca Costigliolo, Elisa Russo, Lucia Macciò, Francesca Viazzi
Pasquale Esposito, Elisa Russo, Lucia Macciò, Francesca Viazzi, Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, Genoa 16132, Italy
Pasquale Esposito, Daniela Picciotto, Francesca Cappadona, Francesca Costigliolo, Elisa Russo, Francesca Viazzi, Unit of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa 16132, Italy
Author contributions: Esposito P, Picciotto D, Cappadona F, and Macciò L wrote the paper; Costigliolo F and Russo E collected the data; Viazzi F revised the final version of the paper.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Pasquale Esposito, MD, PhD, Associate Professor, Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, Via Benedetto XV, Genoa 16132, Italy. pasquale.esposito@unige.it
Received: June 21, 2023
Peer-review started: June 21, 2023
First decision: July 28, 2023
Revised: August 18, 2023
Accepted: August 28, 2023
Article in press: August 28, 2023
Published online: October 15, 2023
Processing time: 109 Days and 15.6 Hours
Abstract

Diabetes mellitus is one of the most common causes of chronic kidney disease. Kidney involvement in patients with diabetes has a wide spectrum of clinical presentations ranging from asymptomatic to overt proteinuria and kidney failure. The development of kidney disease in diabetes is associated with structural changes in multiple kidney compartments, such as the vascular system and glomeruli. Glomerular alterations include thickening of the glomerular basement membrane, loss of podocytes, and segmental mesangiolysis, which may lead to microaneurysms and the development of pathognomonic Kimmelstiel-Wilson nodules. Beyond lesions directly related to diabetes, awareness of the possible coexistence of nondiabetic kidney disease in patients with diabetes is increasing. These nondiabetic lesions include focal segmental glomerulosclerosis, IgA nephropathy, and other primary or secondary renal disorders. Differential diagnosis of these conditions is crucial in guiding clinical management and therapeutic approaches. However, the relationship between diabetes and the kidney is bidirectional; thus, new-onset diabetes may also occur as a complication of the treatment in patients with renal diseases. Here, we review the complex and multifaceted correlation between diabetes and kidney diseases and discuss clinical presentation and course, differential diagnosis, and therapeutic oppor-tunities offered by novel drugs.

Keywords: Diabetes; Diabetic kidney disease; Nondiabetic kidney disease; Biomarkers; Glomerular disease; Kidney biopsy; Sodium-glucose cotransporter-2 inhibitors

Core Tip: The relationship between diabetes and kidney disease is complex. Indeed, in patients with diabetes beyond the development of diabetic kidney disease, other forms of kidney disorders not directly correlated with diabetes may occur. Distinguishing between these conditions is essential to guide clinical management. Additionally, de novo diabetes may complicate the treatment of patients with kidney disease. Finally, growing evidence indicates that new drugs, such as sodium-glucose cotransporter-2 inhibitors, may be effective under both conditions. Herein, we discuss the multifaceted correlation between diabetes and kidney diseases, focusing on clinical presentation, differential diagnosis, and new therapeutic opportunities.