The British Journal of Diabetes & Vascular Disease

 

Advanced Search

Journal Navigation

Journal Home

Subscriptions

Archive

Contact Us

Table of Contents

Sign In to gain access to subscriptions and/or personal tools.
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to Saved Citations
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Request Reprints
Right arrow Add to My Marked Citations
Citing Articles
Right arrow Citing Articles via Google Scholar
Right arrow Citing Articles via Scopus
Google Scholar
Right arrow Articles by Gallagher, H.
Right arrow Articles by Andrews, P. A
Right arrow Search for Related Content
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?
The British Journal of Diabetes & Vascular Disease, Vol. 2, No. 2, 96-100 (2002)
DOI: 10.1177/14746514020020020601

What is diabetic renal disease?

Hugh Gallagher

Peter A Andrews

SW Thames Renal & Transplantation Unit, St Helier Hospital, Carshalton, Surrey, SM5 1AA, UK, pandrews{at}sthelier.sghms.ac.uk

Diabetic nephropathy is the most common indication for long-term renal replacement therapy. In type 1 diabetes, it is rare after less than 10 or more than 35 years of disease, while the incidence in type 2 diabetes is related to the duration of diabetes. It is characterised histologically by mesangial expansion, glomerular basement membrane thickening, and glomerulosclerosis. Glomerular hyperfiltration is usual in the early stages of disease, and is thought to be an important mediator of the observed histological features. Hyperglycaemia-induced biochemical abnormalities, notably the formation of advanced glycation end products, overactivity of the polyol pathway, and protein kinase C activation, play a role in the pathogenesis; genetic factors are also implicated. Glycaemic control is of proven benefit in the early, often clinically silent stages of disease. When significant proteinuria and renal impairment have supervened, blood pressure control and reduction of proteinuria by means of angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists are the most effective therapies to delay progression.

Key Words: type 2 diabetes • pathogenesis • clinical features.

References

  • Held PJ, Port FK, Blagg CR et al. The United States Renal Data System's 1990 Annual Data Report: an introduction. Am J Kidney Dis 1990;16:i-ii.[Medline] [Order article via Infotrieve]
  • Barnes DJ, Pinto JR, Viberti GC The patient with diabetes mellitus. In: Davison AM, Cameron JS, Grunfeld J-P, Kerr DNS, Winnearls CG, eds. Oxford textbook of clinical nephrology. Oxford: Oxford University Press, 1998:723-76.
  • Andersen AR, Christiansen JS, Andersen JK et al. Diabetic nephropathy in type 1 (insulin-dependent) diabetes: an epidemiological study. Diabetologia 1983;25:496-501.[ISI][Medline] [Order article via Infotrieve]
  • Fabre J., Balant LP, Dayer PG et al. The kidney in maturity onset diabetes mellitus: a clinical study of 510 patients. Kidney Int 1982;21:730-8.[ISI][Medline] [Order article via Infotrieve]
  • Heptinstall RH Diabetes mellitus and gout. In: Heptinstall RH, ed. Pathology of the kidney. Boston: Little, 1983:1397-453.
  • Anonymous. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993;329:977-86.[Abstract/Free Full Text]
  • Christiansen JS, Gammelgaard J., Tronier B. et al. Kidney function and size in diabetics before and during initial insulin treatment. Kidney Int 1982; 21:683-8.[ISI][Medline] [Order article via Infotrieve]
  • Schmitz A., Hansen HH, Christensen T. Kidney function in newly diagnosed type 2 (non-insulin-dependent) diabetic patients, before and during treatment. Diabetologia 1989;32:434-9.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Hostetter TH, Rennke HG, Brenner BM The case for intrarenal hypertension in the initiation and progression of diabetic and other glomerulopathies. Am J Med 1982;72:375-80.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Brownlee M., Vlassara H., Cerami A. Nonenzymatic glycosylation and the pathogenesis of diabetic complications. Ann Intern Med 1984;101:527-37.[ISI][Medline] [Order article via Infotrieve]
  • Vlassara H., Brownlee M., Manogue KR et al. Cachectin/TNF and IL-1 induced by glucose-modified proteins: role in normal tissue remodeling. Science 1988;240:1546-68.[Abstract/Free Full Text]
  • Gabbay KH, Merola LO, Field RA Sorbitol pathway: presence in nerve and cord with substrate accumulation in diabetes. Science 1966;151: 209-10.[Abstract/Free Full Text]
  • Shah VO, Scavini M., Nikolic J. et al. Z-2 microsatellite allele is linked to increased expression of the aldose reductase gene in diabetic nephropathy. J Clin Endocrinol Metab 1998;83:2886-91.[Abstract/Free Full Text]
  • Hsueh WA, Anderson PW Hypertension, the endothelial cell, and the vascular complications of diabetes mellitus. Hypertension 1992;20:253-63.[Abstract/Free Full Text]
  • Jeffers BW, Estacio RO, Raynolds MV et al. Angiotensin-converting enzyme gene polymorphism in non-insulin dependent diabetes mellitus and its relationship with diabetic nephropathy. Kidney Int 1997;52:473-7.[ISI][Medline] [Order article via Infotrieve]
  • Earle K., Viberti GC Familial, hemodynamic and metabolic factors in the predisposition to diabetic kidney disease. Kidney Int 1994;45:434-7.[ISI][Medline] [Order article via Infotrieve]
  • Marshall SM, Alberti KG Comparison of the prevalence and associated features of abnormal albumin excretion in insulin-dependent and non-insulin-dependent diabetes. Quart J Med 1989;70:61-71.[Abstract/Free Full Text]
  • Viberti GC, Hill RD, Jarrett RJ et al. Microalbuminuria as a predictor of clinical nephropathy in insulin-dependent diabetes mellitus. Lancet 1982;i:1430-2.
  • Mogensen CE Microalbuminuria predicts clinical proteinuria and early mortality in maturity-onset diabetes. N Engl J Med 1984;310:356-60.[Abstract]
  • Messent JW, Elliott TG, Hill RD et al. Prognostic significance of microalbuminuria in insulin-dependent diabetes mellitus: a twenty-three year follow-up study. Kidney Int 1992;41:836-9.[ISI][Medline] [Order article via Infotrieve]
  • Mattock MB, Morrish NJ, Viberti G. et al. Prospective study of microalbuminuria as predictor of mortality in NIDDM. Diabetes 1992;41:736-41.[Abstract]
  • Anonymous. Effect of intensive therapy on the development and progression of diabetic nephropathy in the Diabetes Control and Complications Trial. Kidney Int 1995;47:1703-20.[ISI][Medline] [Order article via Infotrieve]
  • Viberti GC, Bilous RW, Mackintosh D. et al. Monitoring glomerular function in diabetic nephropathy. Am J Med 1983;74:256-64.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Rossing P., Hommel E., Smidt UM et al. Impact of arterial blood pressure and albuminuria on the progression of diabetic nephropathy in IDDM patients. Diabetes 1993;42:715-9.[Abstract]
  • Gall MA, Nielsen FS, Smidt UM et al. The course of kidney function in type 2 (non-insulin-dependent) diabetic patients with diabetic nephropathy. Diabetologia 1993;36:1071-8.[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Parving HH, Andersen AR, Smidt UM et al. Effect of antihypertensive treatment on kidney function in diabetic nephropathy. BMJ 1987;294: 1443-7.[ISI][Medline] [Order article via Infotrieve]
  • Ravid M., Savin H., Jutrin I. et al. Long-term stabilizing effect of angiotensin-converting enzyme inhibition on plasma creatinine and on proteinuria in normotensive type II diabetic patients. Ann Intern Med 1993;118:577-81.[Abstract/Free Full Text]
  • Viberti GC, Bilous RW, Mackintosh D. et al. Long term correction of hyperglycaemia and progression of renal failure in insulin dependent diabetes. BMJ 1983;286:598-602.[ISI][Medline] [Order article via Infotrieve]
  • Lewis EJ, Hunsicker LG, Bain RP et al. The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. N Engl J Med 1993;329: 1456-62.[Abstract/Free Full Text]
  • Lewis EJ, Hunsicker LG, Clarke WR et al. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med 2001;345:851-60.[Abstract/Free Full Text]
  • Brenner BM, Cooper ME, de Zeeuw D. et al. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med 2001;345:861-9.[Abstract/Free Full Text]
  • Frimodt-Moller C. Diabetic cystopathy. Dan Med Bull 1978;25:49-60.[ISI][Medline] [Order article via Infotrieve]
  • Pappas S., Peppas Th A., Sotiropoulos A. et al. Emphysematous pyelonephritis: a case report and review of the literature. Diabet Med 1993;10:574-6.[ISI][Medline] [Order article via Infotrieve]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?



This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to Saved Citations
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Request Reprints
Right arrow Add to My Marked Citations
Citing Articles
Right arrow Citing Articles via Google Scholar
Right arrow Citing Articles via Scopus
Google Scholar
Right arrow Articles by Gallagher, H.
Right arrow Articles by Andrews, P. A
Right arrow Search for Related Content
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?