## Most Common Cause of CKD in India **Key Point:** Diabetes mellitus is the leading cause of CKD globally and in India, accounting for approximately 30–40% of all CKD cases in developed nations and 20–30% in India. ### Epidemiological Context India has a high burden of type 2 diabetes mellitus due to: - Rapid urbanization and lifestyle changes - Genetic predisposition in Asian populations - Increasing prevalence of metabolic syndrome - Poor glycemic control in many patients ### Pathophysiology of Diabetic Nephropathy Diabetic kidney disease progresses through: 1. **Glomerular hyperfiltration** — early phase with increased GFR 2. **Basement membrane thickening** — nodular glomerulosclerosis (Kimmelstiel-Wilson lesion) 3. **Progressive proteinuria** — microalbuminuria → overt proteinuria 4. **Declining GFR** — progressive loss of nephrons **High-Yield:** Diabetic nephropathy is the single largest cause of end-stage renal disease (ESRD) requiring dialysis or transplantation worldwide. ### Comparative Epidemiology in India | Cause | Frequency in CKD | Notes | |-------|------------------|-------| | Diabetes mellitus | 30–40% | Leading cause; increasing trend | | Chronic glomerulonephritis | 20–30% | Second most common; includes IgA nephropathy | | Hypertension | 15–25% | Often coexists with diabetes | | Chronic pyelonephritis | 5–10% | Less common as primary cause | **Clinical Pearl:** Many Indian patients present with CKD at advanced stages (Stage 4–5) because diabetes and hypertension are often undiagnosed or poorly controlled in primary care settings. **Mnemonic: DHCP** — Diabetes, Hypertension, Chronic glomerulonephritis, Pyelonephritis (in order of frequency in India).
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