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The Kidney and Hypertension in Diabetes Mellitus pp 309–318Cite as

The Concept of Incipient Diabetic Nephropathy and Effect of Early Antihypertensive Intervention

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Abstract

Diabetic nephropathy is the main cause for premature death among type 1, insulin-dependent diabetic subjects [1]. To date, aggressive antihypertensive treatment is the only intervention able to improve prognosis of these patients [2]. The term diabetic nephropathy designates glomerular injury attributable to diabetes [3]. As in all glomerular diseases, its diagnosis is based upon three functional abnormalities: proteinuria (mainly, albuminuria), elevated blood pressure, and reduced glomerular filtration rate. Technical improvements lead to early detection of glomerular dysfunction in type 1, insulin-dependent diabetic subjects: the first ones were sensitive assays for urinary albumin measurement [4,5], also sensitive techniques to detect glomerular hyperfiltration early in the course of diabetic renal disease, and only recently automatic blood pressure monitoring to detect minimal blood pressure changes [6,7]. The concept of incipient diabetic nephropathy was validated by 4 follow-up studies of patients whose urinary albumin was measured serially with sensitive techniques [8–11]. These studies indicated that minimal increases in urinary albumin excretion (UAE) (called microalbuminuria) can have a prognostic value. Therefore, the concept of incipient diabetic nephropathy is based upon the premise that persistent microalbuminuria can already indicate initial glomerular injury, and not only glomerular dysfunction [Chapter 16].

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Authors
  1. Michel Marre
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  2. Gilles Berrut
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  3. Béatrice Bouhanick
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Editor information

Editors and Affiliations

  1. Medical Department M (Diabetes & Endocrinology) Aarhus Kommunehospital, University Hospitals in Aarhus, Aarhus C, Denmark

    Carl Erik Mogensen

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Marre, M., Berrut, G., Bouhanick, B. (1994). The Concept of Incipient Diabetic Nephropathy and Effect of Early Antihypertensive Intervention. In: Mogensen, C.E. (eds) The Kidney and Hypertension in Diabetes Mellitus. Springer, Boston, MA. https://doi.org/10.1007/978-1-4757-6746-9_29

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  • DOI: https://doi.org/10.1007/978-1-4757-6746-9_29

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4757-6748-3

  • Online ISBN: 978-1-4757-6746-9

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