Lipoproteins and Diabetic Kidney Disease

Diabetic kidney disease is a leading cause of kidney failure globally and is associated with greatly increased risk of other diabetes complications, including cardiovascular disease and premature death. Abnormalities of lipoprotein/lipid levels and function are associated with the development and progression of diabetic kidney disease in both type 1 and type 2 diabetes. Some lipid drugs have been associated with mitigation of diabetic kidney damage, and both direct and indirect effects may be involved. Mechanisms of kidney damage and protection by lipoproteins have been postulated, but the strong associations between hyperglycemia, obesity, and albuminuria challenge elucidation of the roles of lipoproteins. In this chapter, we discuss the diagnostic and prognostic significance of lipoprotein-related factors in type 1 and type 2 diabetic kidney disease, briefly discuss the biological implications of lipoprotein composition and functionality, and the renal effects of major lipid drug classes. The assessment and, where appropriate, treatment of lipoproteins in diabetic kidney disease are merited at least to ameliorate the associated accelerated atherosclerosis. Further longitudinal observational studies, clinical trials of lipid drugs with primary kidney end-points, and related basic science studies are warranted.