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Diabetic nephropathy 

Diabetic nephropathy
Chapter:
Diabetic nephropathy
Author(s):

Janaka Karalliedde

and Giancarlo Janaka

DOI:
10.1093/med/9780199235292.003.1521
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date: 19 February 2019

Diabetic nephropathy is classically defined as a rise in urinary albumin excretion rate (UAER), often associated with an increase in blood pressure, with concomitant retinopathy but without evidence of other causes of renal disease (1). It is characterized by a progressive decline in glomerular filtration rate (GFR), eventually resulting in end-stage renal disease. Diabetic nephropathy occurs in approximately 30–35% of type 1 and type 2 patients and tends to cluster in families. These families also show a predisposition to cardiovascular disease and hypertension—and, hypertension, or a predisposition to it, appears a major determinant of diabetic renal disease. These data taken together clearly suggest an individual susceptibility to this complication.

The phases of diabetic nephropathy based on urine albumin excretion status and GFR are shown in Table 13.5.3.1 (2). Histological changes of diabetic glomerulopathy are present in over 95% of patients with type 1 diabetes and albuminuria (UAER >300 mg/day) and in approximately 85% of type 2 diabetic patients who develop albuminuria with concomitant diabetic retinopathy (1, 2). In the absence of diabetic retinopathy nearly 30% of patients with type 2 diabetes and proteinuria have nondiabetic renal lesions (1).

The all-cause mortality in patients with diabetic nephropathy is nearly 20–40 times higher than that in patients without nephropathy. In recent years it has become apparent that renal disease and cardiovascular disease are closely related and diabetic nephropathy is acknowledged as an independent and powerful risk factor for cardiovascular disease (3). Many patients with diabetes and renal impairment die from a cardiovascular disease event before they progress to end-stage renal disease. Diabetic nephropathy is the most common cause of end-stage renal disease worldwide and represent about 30–40% of all patients receiving renal replacement therapy in the Western World.

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