Diabetic kidney disease (also termed “chronic kidney disease” [CKD] due to diabetes or diabetic

nephropathy(DN)) is defined in both type 1 and type 2 diabetes as the presence of persisting
severely elevated albuminuria of >300 mg/24 h (or >200 μg/min), or an albumin-to-creatinine ratio
(ACR) of >300 mg/g, confirmed in at least 2 of 3 samples, with concurrent presence of diabetic
retinopathy and absence of signs of other forms of renal disease.8 As such, this clinical diagnosis
requires only basic clinical and laboratory evaluations. The normal range for albuminuria is <30
mg/g, and the abnormal range is >30 mg/g, but values within both these ranges may be associated
with an elevated risk of renal and cardiovascular disease.9 The presence of moderately elevated
urine albumin excretion (microalbuminuria) (30–300 mg/g) is widely regarded as a precursor of
diabetic nephropathy, both indicating early risk and providing a target for intervention. However,
in some cases microalbuminuria can display remission, either spontaneously or owing to
treatment,10, 11, 12 resulting in a lower renal risk compared with progression of albuminuria.

The broader term “kidney disease in diabetes” is used for patients with CKD (impaired renal
function: estimated GFR [eGFR] < 60 ml/min per 1.73 m2 or proteinuria) regardless of the
background. Although impaired renal function with normal albuminuria (ACR < 30 mg/g) is
prevalent, particularly in elderly individuals, it is much less likely to progress if albuminuria is not
present.13, 14

The Italian Renal Insufficiency and Cardiovascular Events (RIACE) study of more than 15,000
participants with type 2 diabetes suggested that those with elevated albuminuria displayed the
typical microvascular complications, whereas nonalbuminuric individuals with impaired renal
function had a more cardiovascular or macrovascular phenotype.13

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YANG DIBAWAH TAHUN 2013 GANTI JADI : Persson, Frederik, and Peter Rossing.
"Diagnosis of diabetic kidney disease: state of the art and future perspective." Kidney international
supplements 8.1 (2018): 2-7.