Diabetes: Diabetic kidney disease (DKD) is recognized as the predominant ethology of end-stage kidney disease globally and represents the most critical prognostic factor for mortality in patients with diabetes. Diabetic kidney disease affects approximately 20% of the 400 million people worldwide who have diabetes mellitus (DKD). DKD is associated with increased cardiovascular and all-cause morbidity and mortality, so early detection and treatment are critical. The optimal method in order to identify DKD early involves conducting an annual spot urine albumin-to-creatinine ratio test, with the diagnosis confirmed by consistent elevations in urinary albumin excretion upon repeat testing. The pathophysiology of DKD involves multiple mechanisms, including processes related to metabolism, inflammation, and hemodynamic. Hyperglycaemia-induced activation of the electron transport chain leads to a rise in ROS (Reactive Oxygen Species), which is considered a key initiator of diabetes-related complications. Several antihyperglycemic agents, including dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and sodium-glucose cotransporter-2 (SGLT-2) inhibitors, may help prevent the onset and progression of DKD by effectively lowering blood glucose levels and offering inherent renal protection. To prevent microvascular complications, it is essential to monitor blood pressure during each clinical visit and maintain it below 140/90 mm Hg. This article seeks to the patients advancing referring patients to nephrogenic subspecialists may be beneficial if they have stage 3 DKD or more due to the disease’s complexity and the increased risk of adverse outcomes.

Keywords: DKD, Urine Albumin, Hemodynamic, Metabolic, Hyperglycaemia, Antihyperglycemic, Microvascular.