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Prevention and Early Treatment of Diabetic Renal Disease

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Suki and Massry’s THERAPY OF RENAL DISEASES AND RELATED DISORDERS

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Abstract

Throughout the course of diabetes, good metabolic control is of major importance in the prevention of renal disease (1). Later in the diabetic course, several factors appear to affect disease progression, and blood pressure elevation seems the most important factor, readily modifiable. Incipient renal disease in diabetes, detected by the occurrence of microalbuminuria, is frequently characterized by elevated and increasing blood pressure. The increase, however, is most often subtle and may only be detectable by careful monitoring, e.g., 24-hour ambulatory recordings (2). Elevation of blood pressure is found in both types of diabetes, but there seem to be several etiological as well as temporal distinctions between insulin-dependent diabetes mellitus (IDDM) and noninsulin-dependent diabetes mellitus (NIDDM), and some of these variations are clearly explained by the different etiology and nature of the diabetic state (3). In NIDDM patients, higher age, increased body weight, and insulin resistance and related hyperinsulinemia are important factors. Though hypertension secondary to renal impairment is also frequently seen in NIDDM patients, the renal genesis of hypertension is much more predominant in the relatively younger IDDM patients (3). Dietary protein may also be an important modulating factor, but further studies are needed, since this is an area of controversy (4). These three factors—metabolic control, blood pressure elevation, and dietary proteins—and their modification by treatment will be the main focus in this chapter.

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  1. Medical Department M (Diabetes and Endocrinology), Kommunehospitalet, Kommunehospitalet, University Hospital in Aarhus, Aarhus C, DL-8000, Denmark

    Carl Erik Mogensen M.D. (Professor of Medicine)

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  1. Carl Erik Mogensen M.D.
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Wadi N. Suki M.D. Shaul G. Massry M.D.

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Mogensen, C.E. (1998). Prevention and Early Treatment of Diabetic Renal Disease. In: Suki, W.N., Massry, S.G. (eds) Suki and Massry’s THERAPY OF RENAL DISEASES AND RELATED DISORDERS. Springer, Boston, MA. https://doi.org/10.1007/978-1-4757-6632-5_36

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  • DOI: https://doi.org/10.1007/978-1-4757-6632-5_36

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