Diabetic Nephropathy

  • Jordan L. Rosenstock
  • Gerald B. Appel


Diabetes is the most important cause of end stage renal disease (ESRD) in the United States. Over 50% of all new patients entering ESRD programs are now diabetics and over one-third of the entire ESRD population of over 300,000 persons has diabetes mellitus as a cause of renal failure.1 The increase in diabetics as a percentage of all patients developing ESRD has been about 2% annually with no indication of a future decline. The ESRD program cost now exceeds 16 billion dollars annually. The exact percentage of patients with type 1 and type 2 diabetes who will progress to ESRD has been debated. From 25–40% of type 1 patients will develop nephropathy and most will progress to ESRD.2 If a type 1 diabetic has not developed proteinuria at 20–25 years, the risk of renal disease decreases to only a few percent. Of type 2 diabetes patients a smaller percentage will progress to ESRD. Nevertheless, since type 2 diabetics make up a far greater percentage of the overall diabetic population, the total number of diabetics who progress to ESRD is weighted towards type 2 rather than type 1 patients. Moreover, with improved treatment of hypertension and coronary heart disease, more type 2 diabetics are surviving long enough to develop ESRD. White patients have a lower risk of developing ESRD than do Blacks, Hispanics, or native Americans with type 2 diabetes. Almost 50% of diabetic Pima Indians develop nephropathy by 20 years of diabetes and 15% will have progressed by this time to ESRD.


Diabetic Nephropathy United Kingdom Prospective Diabetes Study Efferent Arteriole Hypertension Optimal Treatment Renal Function Worsen 
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© Springer Science+Business Media New York 2004

Authors and Affiliations

  • Jordan L. Rosenstock
  • Gerald B. Appel

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