A Comparison of Progression in Diabetic and Non-Diabetic Renal Disease: Similarity of Progression Promoters

  • Gerjan Navis
  • Paul E. De Jong
  • Dick De Zeeuw

Abstract

The prevention of progressive renal function loss remains the major challenge for nephrologists today. Traditionally the progressive nature of renal function loss was attributed to the underlying disease, with a major role for hypertension [1]. The hypothesis, however, that common mechanisms account for the progressive renal function loss in many different renal conditions regardless the nature of initial renal damage [2], was fuelled by several observations. These include the linear renal function deterioration that occurs in many patients regardless their initial renal disease [3], as well as the similarity in histopathological abnormalities in end-stage kidneys with different underlying diseases. Systemic [4] and glomerular [5] hypertension, proteinuria [6] and lipid abnormalities [7] are assumed to be common mediators in the pathogenesis of focal segmental glomerulosclerosis, the alleged final common pathway of progressive renal disease [8]. Here we will briefly review current knowledge on progressive renal function loss in human diabetic and non-diabetic renal disease and on the response to intervention treatment. As to diabetic patients we will, for the sake of brevity, mainly focus on patients with type I (insulin-dependent) diabetes. We will specifically address the question whether current clinical evidence supports the hypothesis that common mechanisms underlie progressive renal function loss in diabetic and non-diabetic renal disease; this will help to devise future prevention strategies.

Keywords

Diabetic Nephropathy Polycystic Kidney Disease Nephrol Dial Transplant Analgesic Nephropathy Progressive Renal Disease 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Ellis A. Natural history of Bright’s disease; clinical, histological and experimental observations. The vicious circle in Bright’s disease. Lancet 1942; i: 72–76.CrossRefGoogle Scholar
  2. 2.
    Klahr S, Schreiner G, Ichikawa I. The progression of renal disease. N Engl J Med 1988; 318: 1657–1666.PubMedCrossRefGoogle Scholar
  3. 3.
    Mitch WE, Buffington G, Lemaan J, Walser M. Progression of renal failure: a simple method of estimation. Lancet 1976; ii: 1326–1331.CrossRefGoogle Scholar
  4. 4.
    Alvestrand A, Gutierrez A, Bucht H, Bergström J. Reduction of blood pressure retards the progression of chronic renal failure in man. Nephrol Dial Transplant 1988; 3: 624–631.PubMedGoogle Scholar
  5. 5.
    Brenner BM, Meyer TW, Hostetter TW. Dietary protein and the progressive nature of kidney disease: role of hemodynamically mediated glomerular injury in the pathogenesis of progressive glomerular sclerosis of aging, renal ablation and intrinsic renal disease. N Engl J Med 1982; 307: 652–659.PubMedCrossRefGoogle Scholar
  6. 6.
    Williams PS, Fass G, Bone JM. Renal pathology and proteinuria determine progression in untreated mild/moderate chronic renal failure. Q J Med 1988; 67: 343–354.PubMedGoogle Scholar
  7. 7.
    Keane WF, Kasiske B, O’Donnell MP, Kin Y. The role of altered lipid metabolism in the progression of renal disease. Am J Kidney Dis 1991; 17: S38–S42.Google Scholar
  8. 8.
    Remuzzi G, Bertani T. Is glomerulosclerosis a consequence of altered glomerular permeability to macromolecules? [editorial]. Kidney Int 1990; 38: 384–394.PubMedCrossRefGoogle Scholar
  9. 9.
    Mogensen CE. »Natural history and potential prevention of diabetic nephropathy in insulin-dependent and non-insulin-dependent diabetic patients.« In Prevention of Chronic Renal Failure. El Nahas A, Mallick NP, Anderson S, eds. Oxford University Press, 1993; pp 259-302.Google Scholar
  10. 10.
    Levey AS. Measurement of renal function in chronic renal disease. Kidney Int 1990; 38: 167–184.PubMedCrossRefGoogle Scholar
  11. 11.
    Apperloo AJ, de Zeeuw D, Donker AJM, de Jong PE. Precision of GFR determinations for long-term slope calculations is improved by simultaneous infusion of 125I-iothalamate and 131I-Hippuran. JASN 1996; in press.Google Scholar
  12. 12.
    Walser M, Drew HH, LaFrance LD. Creatinine measurements often yield false estimates in chronic renal failure. Kidney Int 1988; 34: 412–418.PubMedCrossRefGoogle Scholar
  13. 13.
    Jones RH, Mackay JD, Hayakawa H, Parsons V, Watkins PJ. Progression of diabetic nephropathy. Lancet 1979; i: 1105–1106.CrossRefGoogle Scholar
  14. 14.
    Bergström J, Alvestrand A, Bucht H, Gutierrez A, Stenvinkel P. Is renal failure always progressive? Contr Nephrol 1989; 75: 60–67.Google Scholar
  15. 15.
    Gall M-A, Nielsen FS, Smidt UM, Parving H-H. The course of kidney fonction in type 2 (non-insulin-dependent) diabetic patients with diabetic nephropathy. Diabetologia 1993; 36; 1071–1078.PubMedCrossRefGoogle Scholar
  16. 16.
    Williams PS, Mallick NP. »The natural history of chronic renal failure.« In Prevention of Chronic Renal Failure. El Nahas A, Mallick NP, Anderson S, eds. Oxford University Press, 1993; pp 210-259.Google Scholar
  17. 17.
    Tarnow L. Genetic pattern in diabetic nephropathy. Nephrol Dial Transplant 1996; 11: 410–412.PubMedCrossRefGoogle Scholar
  18. 18.
    Zatz R, Meyer TW, Rennke HG, Brenner BM. Predominance of hemodynamic rather than metabolic factors in the pathogenesis of diabetic glomerulopathy. Proc Natl Acad Sci 1985; 82; 5963–5967.PubMedCrossRefGoogle Scholar
  19. 19.
    Parving H-H, Kastrup H, Smidt UM, Andersen AR, Feldt-Rasmussen B, Sandahl Christiansen J. Impaired autoregulation of glomerular filtration rate in type I (insulin-dependent) diabetic patients with nephropathy. Diabetologia 1984; 27: 547–552.PubMedCrossRefGoogle Scholar
  20. 20.
    Poulsen PL, Hansen KW, Mogensen CE. Ambulatory blood pressure in the transition from normoto microalbuminuria: a longitudinal study in IDDM. Diabetes 1994; 43: 1248–1253.PubMedCrossRefGoogle Scholar
  21. 21.
    Brazy PC, Fitzwilliam JF. Progressive renal disease: role of race and antihypertensive medications. Kidney Int 1990; 37: 1113–1119.PubMedCrossRefGoogle Scholar
  22. 22.
    Ahlem J. Incidence of human chronic renal insuffiency. A study of the incidence and pattern of renal insufficiency in adults during 1966–71 in Gothenburg. Acta Med Scand 1975; Suppl 582: 1–50.Google Scholar
  23. 23.
    Stenvinkel P, Alvestrand A, Bergström J. Factors influencing progression in patients with chronic renal failure. J Intern Med 1989; 226: 183–188.PubMedCrossRefGoogle Scholar
  24. 24.
    Locatelli F, Marcelli D, Comelli M, Alberti D, Graziani G, Buccianti G, Redaelli B. Giangrande A et al. Proteinuria and blood pressure as causal components of progression to end-stage renal failure. Nephrol Dial Transplant 1996; 11: 461–467.PubMedCrossRefGoogle Scholar
  25. 25.
    Rutherford WE, Blondin J, Miller JP, Greenwalt AS, Vavra JD. Chronic progressive renal disease: rate of change of serum creatinine concentration. Kidney Int 1977; 11; 62–70.PubMedCrossRefGoogle Scholar
  26. 26.
    Hannedouche T, Chaveau P, Fehrat A, Albouze G, Jungers. Effect of moderate protein restriction on the rate of progression of renal failure. Kidney Int 1989; 36: Suppl. 27: S91–S95.Google Scholar
  27. 27.
    Rosman JB, Langer K, Brandi M, Piers-Becht TPM, van der Hem GK, ter Wee PM, Donker AJM. Protein-restricted diets in chronic renal fialure: a four-year follow-up shows limited indications. Kidney Int 1989; 36: Suppl. 27: S96–S102.Google Scholar
  28. 28.
    Wight JP, Salzano S, Brown CB, El Nahas AM. Natural history of chronic renal failure: a reappraisal. Nephrol Dial Transplant 1992; 7: 379–383.PubMedGoogle Scholar
  29. 29.
    Oldrizzi L, Rugiu C, Valvo E, Lupo A, Loschiavo C, Gammaro L, Tessitore N, Fabris A, Panzetta G, Maschio G. Progression of renal failure in patients with renal disease of diverse etiology on protein-restricted diet. Kidney Int 1985; 27: 553–557.PubMedCrossRefGoogle Scholar
  30. 30.
    Mallick NP, Short CD, Hunt LP. How far since Ellis? Nephron 1987; 46: 113–124.PubMedCrossRefGoogle Scholar
  31. 31.
    Woo DJ. Apoptosis and loss of renal tissue in polycystic kidney diseases. N Engl J Med 1995; 333: 18–25.PubMedCrossRefGoogle Scholar
  32. 32.
    Grantham JJ. Polycystic kidney disease: there goes the neighbourhood. N Engl J Med 1995; 333: 56–57.PubMedCrossRefGoogle Scholar
  33. 33.
    Hasslacher C, Ritz E, Terpstra J, Gallasch G, Kunowski G, Rall C. Natural history of nephropathy in type I diabetes. Hypertension 1985; 7: Suppl. II: II74–II78.PubMedGoogle Scholar
  34. 34.
    Mogensen CE, Christensen CK. Blood pressure changes and renal function in incipient and overt diabetic nephropathy. Hypertension 1985; 7: Suppl. II: II64–II73.PubMedGoogle Scholar
  35. 35.
    Rossing P, Hommel E, Smidt U, Parving H-H. Impact of blood pressure and albuminuria on the progression of diabetic nephropathy in IDDM patients. Diabetes 1993; 42: 715–719.PubMedCrossRefGoogle Scholar
  36. 36.
    Apperloo AJ, de Zeeuw D, de Jong PE. Short-term antiproteinuric response to antihypertensive therapy predicts long-term GFR decline in patients with non-diabetic renal disease. Kidney Int 1994; 45: Suppl. 45: S174–S178.Google Scholar
  37. 37.
    Mulec H, Johnson S-A, Björck S. Relation between serum cholesterol and diabetic nephropathy. Lancet 1990; 335: 1536–1538.Google Scholar
  38. 38.
    van Essen GG, Rensma PL, de Zeeuw D, de Jong PE. Association between angiotensin-converting enzyme gene polymorphism and failure of renoprotective therapy. Lancet 1996; 347: 94–95.PubMedCrossRefGoogle Scholar
  39. 39.
    Jacobsen P, Tarnow L, Rossing P, Cambien F, Lecerf L, Poirier P, Parving H-H. The insertion/deletion (I/D) polymorphism in the angiotensin I-converting enzyme predicts the progression of diabetic nephropathy during ACE-inhibition (ACEI) in insulin dependent diabetic (IDDM) patients (Abstract). J Am Soc Nephrol 1995; 6: 450.Google Scholar
  40. 40.
    Hauser AC, Derfler K, Balcke P. Progression of renal insufficiency in analgesic nephropathy: impact of drug abuse. J Clin Epidemiol 1991; 44: 53–56.PubMedCrossRefGoogle Scholar
  41. 41.
    Diabetes Control and Complications Trial Research Group. 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: 977–986.CrossRefGoogle Scholar
  42. 42.
    Parving H-H, Andersen AR, Smidt UM, Svendsen PA. Early aggressive antihypertensive treatment reduces rate of decline in kidney function in diabetic nephropathy. Lancet 1983; i: 1175–1179.CrossRefGoogle Scholar
  43. 43.
    Klahr S, Levey AS, Beck GJ, Caggiula AW, Hunsicker L, Kusek JW, Striker G et al. The effects of dietary protein restriction and blood pressure control on the progression of chronic renal disease. N Engl J Med 1994; 330: 877–884.PubMedCrossRefGoogle Scholar
  44. 44.
    Björck S, Nyberg G, Mulec H, Granerus G, Herlitz H, Aurell M. Beneficial effects of angiotensin converting enzyme inhibition on renal function in patients with diabetic nephropathy. BMJ 1986; 293: 471–474.PubMedCrossRefGoogle Scholar
  45. 45.
    Heeg JE, de Jong PE, van der Hem GK, de Zeeuw D. Reduction of proteinuria by angiotensin converting enzyme inhibition. Kidney Int 1987; 32: 78–83.PubMedCrossRefGoogle Scholar
  46. 46.
    Björk S, Mulec H, Johnson SA, Nordén G, Aurell M. Renal protective effect of enalapril in diabetic nephropathy. BMJ 1992; 304: 339–343.CrossRefGoogle Scholar
  47. 47.
    Lewis EJ, Hunsicker LG, Bain RP, Rohde RD et al. The effect of angiotensin-converting enzyme inhibition on diabetic nephropathy. N Engl J Med 1993; 329: 1456–1462.PubMedCrossRefGoogle Scholar
  48. 48.
    Maschio G, Alberti D, Janin G, Locatelli F, Mann JFE, Motolese M, Ponticelli C, Ritz E, Zuchelli P et al. Effect of the angiotensin converting enzyme inhibitor benazepril on the progression of chronic renal insufficiency. N Engl J Med 1996; 334; 939–945.PubMedCrossRefGoogle Scholar
  49. 49.
    Kamper A-L, Strandgaard S, Leyssac PP. Late outcome of a controlled trial of enalapril treatment in progressive chronic renal failure. Hard end-points and influence of proteinuria. Nephrol Dial Transplant 1995; 10: 1182–1188.PubMedGoogle Scholar
  50. 50.
    Hannedouche T, Landais P, Goldfarb B, El Esper N, Fournier A, Godin M, Durand D, Chanard J, Mognon F, Suc J-M, Grünfeld J-P. Randomised controlled trial of enalapril and beta-blockers in non-diabetic chronic renal failure. BMJ 1994; 309: 833–837.PubMedCrossRefGoogle Scholar
  51. 51.
    Rudberg S, Aperia A, Freyschuss U, Persson B. Enalapril reduces microalbuminuria in young normotensive Type I (insulin-dependent) diabetic patients irrespective of its hypotensive effect. Diabetologia 1990: 33: 470–476.PubMedCrossRefGoogle Scholar
  52. 52.
    Mathiesen ER, Hommel E, Giese J, Parving H-H. Efficacy of captopril in postponing nephropathy in normotensive insulin dependent diabetic patients with microalbuminuria. BMJ 1991; 303: 81–87.PubMedCrossRefGoogle Scholar
  53. 53.
    Apperloo AJ, de Zeeuw D, van Essen GG, de Jong PE. The initial GFR decline on antihypertensive treatment in long-term intervention studies is reversible after withdrawal of treatment (Abstract). JASN 1994; 5: 324.Google Scholar
  54. 54.
    Gansevoort RT, de Zeeuw D, de Jong PE. Long-term benefits of the antiproteinuric effect of ACE-inhibition in non-diabetic renal disease. Am J Kidney Dis 1993: 2: 202–206.Google Scholar
  55. 55.
    Rossing P, Hommel E, Smidt UM, Parving H-H. Reduction in albuminuria predicts diminished progression in diabetic nephropathy. Kidney Int 1994; 45: Suppl. 45: S145–S149.Google Scholar
  56. 56.
    Gansevoort RT, Sluiter WJ, Hemmelder MH, de Zeeuw D, de Jong PE. Antiproteinuric effect of blood-pressure lowering agents: a meta-analysis of comparative trials. Nephrol Dial Transplant 1995; 10: 1963–1974.PubMedGoogle Scholar
  57. 57.
    Maki DD, Ma JZ, Louis TA, Kasiske BL. Long-term effects of antihypertensive agents on proteinuria and renal function. Arch Intern Med 1995; 155: 1073–1080.PubMedCrossRefGoogle Scholar
  58. 58.
    Weidmann P, Schneider M, Böhlen L. Therapeutic efficacy of different antihypertensive drugs in human diabetic nephropathy: an updated meta-analysis. Nephrol Dial Transplant 1995; 10: Suppl. 9: 39–45.PubMedGoogle Scholar
  59. 59.
    Heeg JE, de Jong PE, van der Hem GK, de Zeeuw D. Efficacy and variability of the antiproteinuric effect of lisinopril. Kidney Int 1989; 36: 272–279.PubMedCrossRefGoogle Scholar
  60. 60.
    Mogensen CE, Keane WF, Bennett PH, Jerums G, Parving H-H, Passa P, Steffes MW, Striker GE, Viberti GC. Prevention of diabetic renal disease with special reference to microalbuminuria. Lancet 1995; 346: 1080–1084.PubMedCrossRefGoogle Scholar
  61. 61.
    Klag MJ, Whelton PK, Randall BL, Neaton JD, Brancati FL, Ford CE, Shulman NB, Stamler J. Blood pressure and end stage renal disease in men. N Engl J Med 1996; 334: 13–18.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1996

Authors and Affiliations

  • Gerjan Navis
    • 1
  • Paul E. De Jong
    • 1
  • Dick De Zeeuw
    • 1
  1. 1.Department of Nephrology and Department of Internal MedicineGroningenThe Netherlands

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