Diabetic kidney disease: Radiological assessment and clinical correlations

Abstract

Diabetic kidney disease (DKD) is the leading cause of chronic kidney disease and end-stage kidney disease worldwide. It affects approximately 20%-50% of individuals with diabetes mellitus, with a substantially higher prevalence among patients with type 2 diabetes, in whom it is the primary indication for renal replacement therapy. In type 1 diabetes, DKD typically develops after a latency period of 5-15 years following disease onset, whereas in type 2 diabetes it may already be present at diagnosis, reflecting the often prolonged, subclinical course of hyperglycemia preceding clinical recognition. The pathogenesis of DKD is multifactorial and involves the complex interplay of chronic hyperglycemia, oxidative stress, persistent inflammatory activation, and intrarenal hemodynamic alterations. These mechanisms promote endothelial dysfunction, activation of profibrotic signaling pathways, and structural remodeling of the renal parenchyma, ultimately leading to glomerular hyperfiltration, progressive albuminuria, and a gradual, irreversible decline in estimated glomerular filtration rate. While traditional diagnostic approaches rely heavily on biochemical markers and clinical parameters, radiological imaging has emerged as a crucial complement in the assessment of DKD. This review examines the role of various imaging modalities, including ultrasonography, computed tomography, magnetic resonance imaging, and new emerging techniques, in the evaluation of DKD. Ultrasonography remains the first-line imaging tool, providing valuable information about renal size, echogenicity, and structural abnormalities that correlate with disease progression and functional decline. Advanced imaging techniques offer enhanced capabilities for assessing renal perfusion, fibrosis, and microstructural changes, potentially enabling earlier detection and more precise monitoring of disease progression. The integration of radiological findings with clinical and laboratory data could significantly improve diagnostic accuracy, risk stratification, and therapeutic decision-making. This comprehensive review highlights the current applications, limitations, and future directions of radiological assessment in DKD, emphasizing the importance of multimodal imaging approaches in optimizing patient care and outcomes.

Keywords: Diabetic kidney disease; Diabetic nephropathy; Ultrasonography; Magnetic resonance imaging; Computed tomography; Renal imaging

Core Tip: Radiological imaging plays an increasingly important role in diabetic kidney disease assessment, effectively complementing traditional biochemical markers. Ultrasonography remains the primary imaging modality, while advanced techniques including magnetic resonance imaging and computed tomography provide enhanced evaluation of renal perfusion, fibrosis, and microstructural changes. Integration of multimodal imaging with clinical data improves diagnostic accuracy, enables earlier disease detection, and optimizes therapeutic decision-making, ultimately enhancing patient outcomes in this leading cause of chronic kidney disease.