Hyperfiltration

 Q: Glomerular hyperfiltration is a protective sign in diabetic patients? 

A) Yes 

B) No 

 Answer: B

Early in the course in some diabetic patients the Glomerular Filtration Rate (GFR) becomes higher than normal. This is called glomerular hyperfiltration, and is defined as "GFR 20 percent or more above that in age-matched, healthy controls without diabetes." Unfortunately, it is not a good sign. Hyperfiltration predicts a higher risk of greater albuminuria and so the progression of Diabetic Kidney Disease (DKD). 

These patients benefit from the nephroprotective effect of the renin-angiotensin system (RAS) and sodium-glucose co-transporter 2 (SGLT2) inhibitors.

#nephrology

References:

1. Vora JP, Dolben J, Dean JD, et al. Renal hemodynamics in newly presenting non-insulin dependent diabetes mellitus. Kidney Int 1992; 41:829. 

2. Tonneijck L, Muskiet MH, Smits MM, et al. Glomerular Hyperfiltration in Diabetes: Mechanisms, Clinical Significance, and Treatment. J Am Soc Nephrol 2017; 28:1023. 

3. Magee GM, Bilous RW, Cardwell CR, et al. Is hyperfiltration associated with the future risk of developing diabetic nephropathy? A meta-analysis. Diabetologia 2009; 52:691. 

4. Ruggenenti P, Porrini EL, Gaspari F, et al. Glomerular hyperfiltration and renal disease progression in type 2 diabetes. Diabetes Care 2012; 35:2061.