Diabetic nephropathy

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Abstract

The prevalence of diabetes-related end-stage renal disease has increased considerably in recent years and is expected to continue to increase over the next decade. Approximately 30% to 40% of persons with type 1 diabetes develop nephropathy. In type 2 diabetes the likelihood of progression to nephropathy varies considerably among different ethnic groups. Microalbuminuria is a significant predictor of subsequent nephropathy in patients with either type 1 or type 2 diabetes, and also predicts increased risk of a number of cardiovascular disease outcomes, including mortality. Recent evidence suggests that microalbuminuria reflects a generalized vascular disease process that is associated with increased development of atherosclerosis and impairment of endothelium-dependent blood flow regulation in clinically healthy patients. Guidelines developed by the American Kidney Foundation recommend annual screening for microalbuminuria beginning at the time of diagnosis in patients with type 2 diabetes, and 5 years after diagnosis in patients with type 1 diabetes. Microalbuminuria can regress spontaneously in many cases; factors that are associated with an increased likelihood of microalbuminuria regression include younger age and lower levels of cholesterol, triglycerides, glycosylated hemoglobin A1c (HbA1c), and systolic blood pressure. First-line treatment strategies for microalbuminuria include angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and beta blockers. The progressive course of nephropathy in patients with diabetes is not inevitable, and more intensive therapy intended to correct multiple risk factors simultaneously can produce a greater reduction in the risk of nephropathy progression than conventional treatment strategies. However, even with intensive treatment, few patients are able to reduce their HbA1c values below 6.5%.

Original languageEnglish (US)
JournalAdvanced Studies in Medicine
Volume5
Issue number4 A
Publication statusPublished - Apr 2005

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ASJC Scopus subject areas

  • Medicine(all)

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