Diabetes is the leading cause of kidney disease and kidney failure. Diabetic kidney disease (DKD) management strategies have evolved in recent years, with the introduction of therapies that improve cardiorenal outcomes and glycemic management. In parallel, the archetype of DKD as a single disease is also shifting.

The symposium The Many Faces of Kidney Disease in Diabetes—Not All Are Diabetic Nephropathy on Saturday, June 22, from 3:15 p.m. – 4:15 p.m. ET in Room W307, will explore evolving concepts in DKD. The symposium also will be livestreamed on the virtual meeting platform for registered meeting participants and will be available on-demand following the 84^th Scientific Sessions.

Andrew Advani, BSc, MBChB(Hons), PhD, FRCP(UK), FRCP(Edin), FASN, Head of the Division of Endocrinology and Metabolism at St. Michael’s Hospital and Associate Professor/Clinician Scientist at University of Toronto, Canada, will focus on acute kidney injury (AKI) and its long-term consequences.

“I am going to ask people to think about how we define diabetes complications,” Dr. Advani said. “Diabetes complications can be acute, or they can be chronic. I also want people to move away from the classical microvascular/macrovascular paradigm of diabetes complications and acknowledge that many health problems occur more commonly in people with diabetes that don’t fall neatly into this historical dogma.”

 These can include fractures, cognitive decline, heart failure, and some cancers.

“Like these other health problems, AKI also occurs much more frequently in people with diabetes,” Dr. Advani said. “We are going to be thinking of AKI as a bona fide complication of diabetes. We are going to be thinking about why people with diabetes might be more likely to develop AKI, what the long-term consequences of developing AKI are, and what can be done, both on the clinical and research sides, to improve outcomes for people with diabetes by focusing on AKI.”

In recent years, several new treatments have been developed to slow kidney disease progression in people with chronic kidney disease (CKD) due to diabetes. In contrast, specific treatments for AKI are lacking beyond supportive care, Dr. Advani noted.

“We hope to improve kidney outcomes for people living with diabetes by shining a spotlight on AKI and focusing interest on this area of unmet need,” he said.

Jeffrey B. Hodgin, MD, PhD, University of Michigan, will speak about hypertension and vascular disease in DKD progression.

“Historically, we approach DKD as a monolithic disease to some degree. Work from our institution and from some of my colleagues who are part of the Kidney Precision Medicine Project (KPMP) is aimed at discerning molecular signatures of various renal diseases, including DKD,” said Timothy Sutton, MD, PhD, Associate Professor of Medicine at Indiana University, who will discuss emerging data on molecular subtypes of DKD. “We are trying to tease out potential molecular subtypes and determine their impact on prognosis and implications for therapeutic interventions.”

The KPMP is a multi-year project funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) to further the understanding of and to find new ways to treat CKD and AKI.

The search for molecular signatures was sparked by observations of increased vascularity surrounding the glomerulus seen in kidney biopsies. The focus has been on identifying molecular pathways that correlate with this neovascularization and determining their potential prognostic, diagnostic, and therapeutic implications.

By using the extent of vascular changes as a timeline of DKD progression, researchers are starting to lay the groundwork for delineating molecular subtype phenotyping of DKD, Dr. Sutton said. He added that, in the future, molecular classification may help identify patients at higher risk of progression earlier in their disease course.

“I think there is a lot of promise in some of the emerging data, and that is a ray of hope for our patients,” Dr. Sutton said.