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Diabetic nephropathy is an important cause of morbidity and death amongst diabetics.
30% **of patients with type 1 diabetes go on to develop chronic renal failure
25% ***of patients with type 2 diabetes develop CRF though this level may be 50%
in certain ethnic groups
The incidence of diabetic nephropathy increases
with age. It almost never occurs in childhood.
Different forms of nephropathy:
pyelonephritis - which may show papillary necrosis
Kimmelstiel-Wilson - eosinophilic nodules in the glomerular tuft
atherosclerosis and hypertensive changes
albuminuria is a sensitive early predictor of subsequent overt renal disease
proteinuria is usually the earliest clinical sign of nephropathy.
is not a feature of early nephropathy. Hypertension is a feature associated with
a more rapid progression of diabetic nephropathy.
- nodular sclerosis (Kimmelstiel-Wilson),
although the most specific form of diabetic nephropathy, only accounts for less
than 20% of renal involvement
Insulin requirements are often reduced
in diabetic nephropathy because the kidneys clear insulin from the blood of normal
Diabetic nephropathy is frequently associated with diabetic
retinopathy and neuropathy.
There is increasing evidence that the risks
of end-stage renal disease (need for dialysis) (ESRD) in type 1 and type 2 diabetes
is lower than previously estimated:
- ** a cohort study in type 1 diabetics
was followed up for maximally 37 years, with a median of 16.7 years (1)
incidence of ESRD was 2.2% at 20 years and 7.8% at 30 years after diagnosis
risk of developing ESRD was lowest in patients whose diagnosis occurred at younger
than 5 years
- risk of ESRD was lower for patients diagnosed as having
type 1 diabetes in later years of the study
- *** a cohort
study in type 2 diabetics has provided evidence that the individual risk of ESRD
and chronic renal failure is low (2)
- in this cohort, only 10 of 1,408
patients followed for 10 years developed ESRD, giving an incidence rate of 1.0
per 1,000 person-years, whereas cumulative risks for chronic renal failure adjusted
for competing mortality were 6.1 and 9.3% after 20 and 30 years from diagnosis
of diabetes, respectively.
P et al. Incidence of end-stage renal disease in patients with type 1 diabetes.JAMA
G et al. Low incidence of end-stage renal disease and chronic renal failure in
type 2 diabetes: a 10-year prospective study. Diabetes Care. 2003 Aug;26(8):2353-8.
Last edited 11/2018