Diabetic nephropathy. Future avenue

• Published in: Diabetes care Vol. 15; no. 9; pp. 1216 - 1225
• Main Authors: VIBERTI, G, YIP-MESSENT, J, MOROCUTTI, A
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.09.1992
• Subjects: Associated diseases and complications; Biological and medical sciences; Diabetes. Impaired glucose tolerance; Diabetic Nephropathies - complications; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Humans; Medical sciences; Proteinuria - complications; Endocrinopathy; Human; Hypertension; Prevention; Urinary system disease; Nephropathy; Diabetes mellitus; Renal failure; Cardiovascular disease; Complication
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/diacare.15.9.1216

Diabetic nephropathy. Future avenue. G C Viberti , J Yip-Messent and A Morocutti Unit for Metabolic Medicine, United Medical School, Guy's Hospital, London, United Kingdom. Abstract Diabetes mellitus has become the leading cause of ESRF in the United States. Patients with diabetic nephropathy suffer high cardiovascular morbidity and mortality. Because only 40% of diabetic patients eventually develop diabetic kidney disease, it may be possible to devise primary prevention measures targeted at the subset of patients at risk. Recently, a predisposition to hypertension, a family history of diabetic nephropathy, and a family history of CVD disease each have been associated independently with the development of diabetic renal complication in IDDM. Risk factors for macrovascular damage, including raised arterial BP, dyslipidemia, and insulin resistance, can be detected early in the course of progression to diabetic nephropathy. These risk indicators recently have been shown to be already present at the stage of normoalbuminuria in those patients who eventually will progress to microalbuminuria. Treatment of established renal disease can only delay the onset of ESRF, and lowering of microalbuminuria has been shown to retard the onset of persistent proteinuria. However, no study to date has demonstrated prevention of renal disease in these patients. The ultimate aim should, therefore, be the prevention of the transition from normoalbuminuria to microalbuminuria in individuals who are at higher risk of diabetic renal disease and CVD.