Diabetic Nephropathy

Diabetic nephropathy is the single most important cause of end-stage renal disease in the United States, with diabetic patients accounting for approximately 40% all patients enrolled in the renal disease program.

The cumulative incidence of is 30% to 50% in type 1 diabetes and about 20% in type 2 diabetes, although certain populations of patients with type 2 diabetes(e.g., Pima Indians) have a higher incidence of nephropathy.

More than half of patients with ESRD type 2 diabetes. secondary to diabetes available data strongly support the concept that diabetic nephropathy is a direct result of the metabolic derange ments seen in diabetics and that normalization of carbohydrate metabolism would be protective against the development of renal disease. In early diabetes, some of the biochemical alterations can lead to hyperfiltration the biochemic with the GFR elevated above normal by 20% to 30%. Diabetic nephropathy is a clinical syndrome characterized by persistent albuminuria(>300 mg/24 a relentless decline in GFR, and raised arterial blood pressure. Nephropathy diabetes, after which the incidence increases until it reaches a peak at approximately 15 to 20 years of diabetes. Several studies have suggested that microalbuminuria ,being defined as a urinary albumin excretion rate ug/min) and less than or greater than 30 mg/24 hr equal to 300 mgl24 hr(200 Aug/min), strongly predicts the development of diabetic nephropathy in both types of diabetes. Excessive cardiovascular has been associated with microalbuminuria. One to 5 years after the onset of microalbuminuria, proteinuria increases and can be detected by protein dipstick measurement on proteinuria is associated with a significant risk for the development or worsening of existing hypertension and progressive decline in renal function.

Once proteinuria is established renal function declines, with 50% of patients reaching end-stage renal disease in 7 to 10 years after the onset of proteinuria. The rate at which patients with protein progress is but if the is untreated, the GFR may at an average rate of mL/min/mo. A high percentage of patients with type 2 diabetes(in contrast to type 1 diabetes) have modest proteinuria and hypertension when initially seen, indicating that other diseases may be responsible for the renal damage. Diabetic retinopathy is found in more than 90% of patients with type 1 diabetes nearly one third of the patients with type 2 diabetes diabetic nephropathy have evidence of

.Regardless the absence of retinopathy and or renal insufficiency without proteinuria, presence of red blood cell casts, and low levels of complement should lead to a search for other causes of renal disease.