Diabetic nephropathy in type 2 diabetes – from pathological mechanisms to clinical occupational medicine practice

Employees with diabetes and nephropathy need special medical surveillance that involves occupational medicine specialists. However, diabetes is not a unique phenotype and each patient need to be carefully assessed. Age, gender, body mass index, renal function impairment (eGFR, creatinine, urea, uric acid), indicators of diabetes control (fasting glycaemia and HbA1C), the presence of co-morbidities, dyslipidaemia, level of serum albumin and total protein, cytokines and other inflammatory markers should be considered in a comprehensive evaluation of the severity of the chronic kidney disease and of the treatment plan. Chronic kidney disease in type 2 diabetes has many facets and various degrees of severity; therefore, permanent communication between the occupational medicine specialist and the treating physician should be maintained. For this purpose, this article reviews the current pathological mechanisms proposed for the explanation of the chronic kidney disease, the diagnostic and the general therapeutic recommendations and also the possible occupational interventions in patients with type 2 diabetic nephropathy.