Skip to main content
SpringerLink
Log in

Risk Factors for Progression of Renal Insufficiency in Diabetic Nephropathy: Therapeutic Implications

  • Chapter
International Yearbook of Nephrology 1991

Part of the book series: International Yearbook of Nephrology 1991 ((IYNE,volume 3))

  • 43 Accesses

Abstract

Clinical diabetic nephropathy has three manifestations: persistent proteinuria, arterial hypertension and a falling glomerular filtration rate (GFR). The spontaneous course is relentless and the prognosis poor. Within 8 years after onset of persistent proteinuria about 50% of Type 1 (insulin dependent) patients develop end-stage renal failure (1, 2) or die of cardiovascular disease (3). In 1989, several reports of a dramatically improved prognosis were published (4–6). As many as 85-90% of proteinuric patients may now survive for 8 years without renal replacement therapy. These results were obtained in diabetic clinics where antihypertensive treatment was introduced early. Figure 1 shows much lower blood pressure levels in the patients with improved survival. Whether or not other factors contributed to this better outcome is not clear. As in other forms of renal disease, the process of progression of renal insufficiency in diabetic nephropathy is certainly multifactorial (7–10). Only the most studied risk factors will be discussed in the following. Each such factor should ideally be dealt with separately. However, their effects are often superimposed in the studies as in life.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Knowles HC Jr: Long-term juvenile diabetes treated with unmeasured diet. Trans Assoc Am Physicians, 84: 95–101, 1971.

    PubMed  Google Scholar 

  2. Andersen AR, Sandahl Christiansen J, Andersen JK, Kreiner S, Decken T: Diabetic nephropathy in type 1 (insulin dependent) diabetes: an epidemiological study. Diabetologia, 25: 496–501, 1983.

    Article  PubMed  CAS  Google Scholar 

  3. Borch-Johnsen K, Kreiner S, Deckert T: Mortality of type 1 (insulin-dependent) diabetes mellitus in Denmark: a study of relative mortality in 2930 Danish Type 1 diabetic patients diagnosed from 1933 to 1972. Diabetologica, 29: 767–772,1986.

    Article  CAS  Google Scholar 

  4. Parving H-H, Hommel E: Prognosis in diabetic nephropathy. Br Med J, 299: 230–233,1989.

    Article  CAS  Google Scholar 

  5. Mathiesen ER, Borch-Johnsen K, Jensen DV, Decken T: Improved survival in patients with diabetic nephropathy. Diabetologia, 32: 884–886,1989.

    Article  PubMed  CAS  Google Scholar 

  6. Hasslacher Ch, Borgholte G, Ritz E, Wahl P: Impact of hypertension on prognosis in IDDM. Diabete Metabol, 15: 338–342,1989.

    CAS  Google Scholar 

  7. Fine LG: Preventing the progression of human renal disease: Have rational therapeutic principles emerged? Kidney Int, 33:116–128,1988.

    Article  PubMed  CAS  Google Scholar 

  8. Klahr S, Schreiner G, Ichikawa I: The progression of renal disease. N Engl J Med, 318: 1657–1666, 1988.

    Article  PubMed  CAS  Google Scholar 

  9. El Nahas AM: Glomerulosclerosis: Insights into pathogenesis and treatment. Nephrol Dial Transpl, 4: 843–853, 1989.

    Google Scholar 

  10. Nyberg G, Nordén G, Bjérck S, Larsson O: Progression of diabetic nephropathy — a multifactorial process. Scand J Urol Nephrol, Suppl.l08:35–40,1988.

    Google Scholar 

  11. Shemesh O, Golbelz H, Kriss JP, Myers BD: Limitations of creatinine as a filtration marker in glomerulopathic patients. Kidney Int, 28: 830–838,1985.

    Article  PubMed  CAS  Google Scholar 

  12. Nordén G, Björck S, Granerus G, Nyberg G: Estimation of renal function in diabetic nephropathy. Nephron, 47: 36–42,1987.

    Article  PubMed  Google Scholar 

  13. Mathillas O, Attman PO, Aurell M, Delin K, Granerus G: Conflicting results between glomerular filtration rate and serum creatinine measurements in chronic renal failure. Contrib Nephrol, 53: 71–73,1986.

    PubMed  CAS  Google Scholar 

  14. Jones RH, Hayakawa H, Mackay JD, Parsons V, Watkins PJ: Progression of diabetic nephropathy. Lancet, I: 1105–1106,1979.

    Article  Google Scholar 

  15. Viberti GC, Bilous RW, Mackintosh D, Keen H: Monitoring glomerular function in diabetic nephropathy. Am J Med, 74: 256–264,1983.

    Article  PubMed  CAS  Google Scholar 

  16. Viberti GC, Keen H: The patterns of proteinuria in diabetes mellitus. Diabetes, 33: 686–692, 1984.

    PubMed  CAS  Google Scholar 

  17. Parving H-H, Andersen AR, Smidt UM, Svendsen PAa: Early aggressive antihypertensive treatment reduces rate of decline in kidney function in diabetic nephropathy. Lancet, I: 1175–1179, 1983.

    Article  Google Scholar 

  18. Parving H-H, Andersen AR, Smidt UM, Hommel E, Mathiesen ER, Svendsen PAa: Effect of antihypertensive treatment on kidney function in diabetic nephropathy. Br Med J, 294: 1443–1447, 1987.

    Article  CAS  Google Scholar 

  19. Parving H-H, Hommel E, Smidt UM: Protection of kidney function and decrease in albuminuria by captopril in insulin-dependent diabetics with nephropathy. Br Med J, 297:1086–1091,1988.

    Article  CAS  Google Scholar 

  20. Parving H-H, Hommel E, Damkjar Nielsen M, Diese J: Effect of captopril on blood pressure and kidney function in normotcnsive insulin dependent diabetics with nephropathy. Br Med J, 299: 533–536,1989.

    Article  CAS  Google Scholar 

  21. Walker JD, Bending JJ, Dodds RA, Mattock MB. Murrells TJ, Keen H, Viberti GC: Restriction of dietary protein and progression of renal failure in diabetic nephropathy. Lancet, II: 1411–1414,1989.

    Article  Google Scholar 

  22. Viberti GC, Bilous RW, Mackintosh D, Bending JJ, Keen H: Long term correction of hyperglycaemia and progression of renal failure in insulin dependent diabetes. Br Med J, 286: 598–602,1983.

    Article  CAS  Google Scholar 

  23. Mogensen CE: Long-term antihypertensive treatment inhibiting progression of diabetic nephropathy. Br Med J, 285: 685–688,1982.

    Article  CAS  Google Scholar 

  24. 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, 293: 467–470, 1986.

    Article  Google Scholar 

  25. Mogensen CE: Progression of nephropathy in long-term diabetics with proteinuria and effect of initial anti-hypertensive treatment. Scand J Clin Lab Invest, 36: 383–388,1976.

    Article  PubMed  CAS  Google Scholar 

  26. Mathiesen ER, Oxenboll B, Johansen K, Svendsen PAa, Decken T: Incipient nephropathy in type 1 (insulin-dependent) diabetes. Diabetologia, 26:406–410,1984.

    Article  PubMed  CAS  Google Scholar 

  27. Feldt-Rasmussen B, Mathiesen ER, Decken T: Effect of two years of strict metabolic control on progression of incipient nephropaty in insulin-dependent diabetes. Lancet, II: 1300–1304,1986.

    Article  Google Scholar 

  28. Feldt-Rasmussen B, Mathiesen ER, Decken T, Giese J, Christensen NJ, Bent-Hansen L, Nielsen MD: Central role for sodium in the pathogenesis of blood pressure changes independent of angiotensin, aldosterone and catecholamines in Type 1 (insulin-dependent) diabetes mellitus. Diabetologia, 30: 610–617, 1987.

    PubMed  CAS  Google Scholar 

  29. Friedman EA: Diabetic nephropathy: Strategies in prevention and management. Kidney Int, 21: 780–791,1982.

    Article  PubMed  CAS  Google Scholar 

  30. Hommel E, Mathiesen E, Edsberg B, Bahnsen M, Parving H-H: Acute reduction of arterial blood pressure reduces urinary albumin excretion in Type 1 (insulin-dependent) diabetic patients with incipient nephropathy. Diabetologia, 29: 211–215, 1986.

    Article  PubMed  CAS  Google Scholar 

  31. Williams PS, Fass G, Bone JM: Renal pathology and proteinuria determine progression in unireated mild/moderate chronic renal failure. Quart J Med, 67: 343–354,1988.

    PubMed  CAS  Google Scholar 

  32. OHare JA, Ferriss JB, Brady D, Twomey B, O’Sullivan DJ: Exchangeable sodium and renin in hypertensive diabetic patients with and without nephropathy. Hypertension, 7(Suppl II): 43–48, 1985.

    Google Scholar 

  33. O’Hare JP, Roland JM, Walters G, Corrall RJM: Impaired sodium excretion in response to volume expansion induced by water immersion in insulin-dependent diabetes mellitus. Clin, 71: 403–409,1986.

    CAS  Google Scholar 

  34. Hostetter TH, Rennke HG, Brenner BM: The case for intrarenal hypertension in the initiation and progression of diabetic and other glomerulopathies. Am J Med, 72: 375–380,1982.

    Article  PubMed  CAS  Google Scholar 

  35. Zatz R, Dunn BR, Meyer TW, Anderson S, Rennke HG, Brenner BM: Prevention of diabetic glomerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest, 77: 1925–1930, 1986.

    Article  PubMed  CAS  Google Scholar 

  36. Parving H-H: Low-protein diet and progression of renal disease in diabetic nephropathy. Lancet, 335:411,1990.

    Google Scholar 

  37. Sawicki PT, Miihlhauser I, Baba T, Berger M: Do angiotensin converting enzyme inhibitors represent a progress in hypertension care in diabetes mellitus? Diabetologia, 33:121–124,1990.

    Article  PubMed  CAS  Google Scholar 

  38. Pollare T, Lithell H, Berne C: A comparison of the effects of hydrochlorothiazide and captopril on glucose and lipid metabolism in patients with hypertension. N Engl J Med, 321: 868–873, 1989.

    Article  PubMed  CAS  Google Scholar 

  39. Björck S, Mulec H, Johnsen SAa, Nyberg G, Aurell M: Contrasting effects of enalapril and metoprolol on proteinuria in diabetic nephropathy. Br Med J, 1990 (in press).

    Google Scholar 

  40. Wiseman M, Viberti G, Mackintosh D, Jarrett RJ, Keen H: Glycaemia, arterial pressure and micro-albuminuria in Type 1 (insulin-dependent) diabetes mellitus. Diabetologia, 26: 401–405, 1984.

    Article  PubMed  CAS  Google Scholar 

  41. Dahl-Jørgensen K, Hanssen KF, Kierulf P, Bjøro T, Sandvik L, Aagenaes Ø: Reduction of urinary albumin excretion after 4 years of continuous subcutaneous insulin infusion in insulin-dependent diabetes mellitus. The Oslo Study. Acta Endocrinol (Copenh.), 117:19–25,1988.

    PubMed  Google Scholar 

  42. McCance DR, Hadden DR, Atkinson AB, Archer DB, Kennedy L: Long-term glycaemic control and diabetic retinopathy. Lancet, II: 824–828,1989.

    Article  Google Scholar 

  43. Nørgaard K, Storm B, Graae M, Feldt-Rasmussen B: Elevated albumin excretion and retinal changes in children with Type 1 diabetes are related to long-term poor blood glucose control. Diabetic Med, 6: 325–328,1989.

    Article  PubMed  Google Scholar 

  44. Nyberg G, Blohmé G, Norden G: Impact of metabolic control in progression of clinical diabetic nephropathy. Diabetologia, 30: 82–86,1987.

    PubMed  CAS  Google Scholar 

  45. Viberti G, Keen H, Dodds R, Bending JJ: Metabolic control and progression of diabetic nephropathy. Diabetologia, 30: 481–482, 1987.

    Article  PubMed  CAS  Google Scholar 

  46. Nyberg G: Metabolic control and progression of diabetic nephropathy. Response from the authors. Diabetologia, 10: 82, 1987.

    Google Scholar 

  47. Bending JJ, Pickup JC, Viberti GC, Keen H: Glycaemic control in diabetic nephropathy. Br Med J, 288: 1187–1191, 1984.

    Article  CAS  Google Scholar 

  48. Mühlhauser I, Berger M, Sonnenberg G, Koch J, Jörgens V, Schernthaner G, Scholz V: Incidence and management of severe hypoglycemia in 434 adults with insulin-dependent diabetes mellitus. Diabetes Care, 3: 268–273,1985.

    Article  Google Scholar 

  49. Bergström J: Discovery and rediscovery of low protein diet Clin Nephrol, 21: 29–35,1984.

    PubMed  Google Scholar 

  50. Zatz R, Meyer TW, Rennke HG, Brenner BM: Predominance of hemodynamic rather than metabolic factors in the pathogenesis of diabetic glomerulopathy. Proc Natl Acad USA, 82: 5963–5967,1985.

    Article  CAS  Google Scholar 

  51. Nyberg G, Nordén G, Attman P-O, Aurell M, Uddebom G, Arvidsson Lenner R, Isaksson B: Diabetic nephropathy: Is dietary protein harmful? J Diabetic Complications, 1: 37–40,1987.

    Article  CAS  Google Scholar 

  52. Wiseman MJ, Bognetti E, Dodds R, Keen H, Viberti GC: Changes in renal function in response to protein restricted diet in Type 1 (insulin-dependent) diabetic patients. Diabetologia, 30: 154–159.1987.

    Article  PubMed  CAS  Google Scholar 

  53. Kupin WL, Cortes P, Dumler F, Feldkamp CS, Kilates MC, Levin NW: Effect on renal function of change from high to moderate protein intake in Type I diabetic patients. Diabetes, 36: 73–79,1987.

    Article  PubMed  CAS  Google Scholar 

  54. Bending JJ, Dodds RA, Keen H, Viberti GC: Renal response to restricted protein intake in diabetic nephropathy. Diabetes, 37: 1641–1646,1988.

    Article  PubMed  CAS  Google Scholar 

  55. Ihle BU, Becker GJ, Whitworth JA, Charlwood RA, Kincaid-Smith PS: The effect of protein restriction on the progression of renal insufficiency. N Engl J Med, 321: 1773–1777,1989.

    Article  PubMed  CAS  Google Scholar 

  56. Levine SE, D’Elia JA, Bistrian B, Smith-Ossman S, Gleason R, Mitch WE, Miller DG: Protein-restricted diets in diabetic nephropathy. Nephron, 52: 55–61,1989.

    Article  PubMed  CAS  Google Scholar 

  57. Attman P-O, Bucht H, Larsson O. Uddebom G. Protein-reduced diet in diabetic renal failure. Clin Nephrol, 19:217–220,1983.

    PubMed  CAS  Google Scholar 

  58. Laakso M, Pyörälä K, Sarlund H, Voutilainen E: Lipid and lipoprotein abnormalities associated with coronary heart disease in patients with insulin-dependent diabetes mellitus. Arteriosclerosis, 6: 679–684,1986.

    Article  PubMed  CAS  Google Scholar 

  59. Betteridge DJ: Lipids, diabetes and vascular disease: the time to act. Diabetic Med, 6: 195–218, 1989.

    Article  PubMed  CAS  Google Scholar 

  60. Jensen T, Stender S, Deckert T: Abnormalities in plasma concentrations of lipoproteins and fibrinogen in Type 1 (insulin-dependent) diabetic patients with increased urinary albumin excretion. Diabetologia, 31: 142–145,1988.

    Article  PubMed  CAS  Google Scholar 

  61. Vannini P, Ciavarella A, Hammini M, Bargossi AM, Forlani G, Borgnino LC, Orsoni G: Lipid abnormalities in insulin-dependent diabetic patients with albuminuria. Diabetes Care, 7: 151–154, 1984.

    Article  PubMed  CAS  Google Scholar 

  62. Jensen T, Borch-Johnsen K, Kofoed-Enevoldsen A, Decken T: Coronary heart disease in Type 1 (insulin dependent) diabetes patients with and without diabetic nephropathy: incidence and risk factors. Diabetologia, 30: 144–148,1987.

    Article  PubMed  CAS  Google Scholar 

  63. Moorhead JF, El Nahas AM, Chan MK, Varghese Z: Lipid nephrotoxicity in chronic progressive glomerular and tubulo-interstitial disease. Lancet, II: 1309–1311,1982.

    Article  Google Scholar 

  64. Keane WF, Kasiske BL, O’Dtonnell MP: Lipids and progressive glomerulosclerosis. Am J Nephrol, 8: 261–271,1988.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Nephrology, Sahlgrenska Hospital, Göteborg, Sweden

    Gudrun Nyberg

Authors
  1. Gudrun Nyberg
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Nephrology, University of Naples, Naples, Italy

    Vittorio E. Andreucci

  2. Division of Nephrology, UCLA School of Medicine, University of California, Los Angeles, California, USA

    Leon G. Fine

Rights and permissions

Reprints and permissions

Copyright information

© 1990 Springer Science+Business Media Dordrecht

About this chapter

Cite this chapter

Nyberg, G. (1990). Risk Factors for Progression of Renal Insufficiency in Diabetic Nephropathy: Therapeutic Implications. In: Andreucci, V.E., Fine, L.G. (eds) International Yearbook of Nephrology 1991. International Yearbook of Nephrology 1991, vol 3. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-3946-9_8

Download citation

  • DOI: https://doi.org/10.1007/978-1-4615-3946-9_8

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4613-6761-1

  • Online ISBN: 978-1-4615-3946-9

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation