This document discusses changes in concepts and management of diabetic kidney disease. It notes the large disease burden and challenges in developing solid concepts due to complex pathophysiology and changing natural history. Standard measures like eGFR and UACR are sometimes lacking. New paradigms include different disease trajectories and revised models based on albuminuria. Pillars of management discussed include SGLT2 inhibitors, GLP-1 agonists, RAAS blockade, MRAs, and lifestyle changes/metformin. Landmark trials support maximum RAAS blockade doses. SGLT2 inhibitors are recommended in KDIGO 2022 guidelines due to benefits shown in recent studies. Terminology, phenotypes, and treatment guidelines from ADA and KDIGO

1. Do We Have A
Paradigm Shift?
Applied
Concepts in
Diabetic
Kidney
Disease
Emad Magdy Shawky
Lecturer and consultant of Nephrology, Mansoura University

2. AGENDA
Disease Burden
Challenges to get fixed
concepts
Pillars of Management
Home Messages

3. Disease
Burden

4. Magnitude of the problem

5. Magnitude
of the
problem

6. It is not just the kidney

7. Mortality in HD patients

8. Under which care?

9. Are they even
adequately
treated?

11. This reflects also the shortage in standard
measures (eGFR, UACR)

12. The shortage in standard measures (eGFR, UACR)

13. The shortage in standard measures (eGFR, UACR)

14. The shortage in standard measures (eGFR, UACR)

16. There was NDKD between the diabetics
Spectrum of Histopathological Findings
Nodular diabetic glomerulosclerosis Diffuse diabetic glomerulosclerosis
Membranous GN Focal segmental glomerulosclerosis
IgA nephropathy Amyloid AL
Focal Necrotizing GN Minimal change disease
Tubulo-interstitial Nephritis

17. The shortage in standard measures (eGFR, UACR)

18. The shortage in standard measures (eGFR, UACR)

19. The shortage in standard measures (eGFR, UACR)

20. The shortage in standard measures (eGFR, UACR)

21. Do we have
totally agreed
concepts?

22. Complex inter-related
pathophysiologic mechanisms
New paradigms in natural
history of the disease
2
challenges
in driving
solid
concepts

23. Complex inter-related
pathophysiologic mechanisms
2
challenges
in driving
solid
concepts

27. New paradigms in natural
history of the disease
2
challenges
in driving
solid
concepts

28. Albuminuria
based model
old and New

29. Juntendo Medical Journal 65 (6), 2019

30. Trajectories of kidney function in diabetes: a clinicopathological update

36. So, Let us
Revise the
Evidence

37. Pillars for DKD Management in 2022
GLP1
agonists
Lifestyle +
Metformin
MRAs
RAAS
Blockade
SGLT2i

38. RAAS
Blockade

39. Landmark Trials

43. Maximum
tolerable
dose is Q

44. Their Place
in KDIGO
2022
Guidelines

45. SGLT2i

47. SGLT between 2020 and 2022

48. SGLT between 2020 and 2022

49. SGLT between 2020 and 2022

50. Initial GFR Drop
Alejandro Y.Kidney360 June 2021, 2 (6) 1042-1047

52. Sophia Zoungas1 and Ian H. de Boer CJASN 16, 2021

54. GLP 1- A

55. GLP1 agonists between 2020 and 2022

56. GLP1 agonists between 2020 and 2022

58. MRAs

60. Home
Messages

61. Terminology

62. DKD phenotypes and trajectories

63. ADA 2020, KDIGO 2022

64. Springer Nature Switzerland AG 2022
E. V. Lerma, V. Batuman (eds.), Diabetes and Kidney
Disease
Patient factors influencing the
selection of glucose-lowering
drugs other than SGLT2i and
metformin in T2D & CKD

65. Antidiabetic Drugs and Kidney

66. Antidiabetic drugs and Kidney- ctd

67. Thank You