Resumen

SILVA, Regina; MENG, Catarina  y  COENTRAO, Luís. Diabetic Nephropathy and its two phenotypes: the proteinuric and non-proteinuric. Port J Nephrol Hypert [online]. 2017, vol.31, n.2, pp.122-131. ISSN 0872-0169.

The typical progression of diabetic nephropathy is from the normoalbuminuric stage to microalbuminuria (urinary albumin creatinine rate, UACR, 30-300 mg/g) to end in overt proteinuria. A growing body of recent evidence has shown an accelerated decrease in glomerular filtration rate predominately seen in normoalbuminuric patients with type 2 diabetes. This discovery raises the the possibility of there being two independent diabetic nephropathy phenotypes. The aim of this review is to collect, summarize and compare the most relevant data referring to both the classical/proteinuric (UACR>300mg/g) and the non-classical/ non-proteinuric (UACR < 300 mg/g) phenotypes in type 2 diabetic patients. PubMed research into diabetic nephropathy and both proteinuric and non-proteinuric phenotypes was undertaken. A total of 67 articles were included. Several studies have shown that diabetic nephropathy may co-exist within a normal range of albumin excretion. This new emerging phenotype is nowadays extremely frequent in type 2 diabetic patients, and seems to be found more often in female sex, older adults, and patients with metabolic syndrome. Albumin does not seem to be the best marker for this phenotype. New possible markers for early stage renal disease were found. Treatment with Renin-Angiotensin-System inhibitors, according to evidence, might not be the most adequate therapy for non-proteinuric diabetic patients. Prognosis is still unclear. This new diabetic nephropathy phenotype exists and clinicians should be aware of it, to ensure these patients are not underdiagnosed. More research is needed to clarify this phenotype’s epidemiology, pathogenesis, risk factors, diagnosis methods, new biomarkers, best treatment approach and its prognosis

Palabras clave : Albuminuria; Diabetes mellitus; type 2; Diabetic nephropathies; Glomerular Filtration Rate; Renal Insufficiency; chronic.

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