The Concept of Incipient Diabetic Nephropathy and Effect of Early Antihypertensive Intervention
Diabetic nephropathy is the main cause for premature death among type 1, insulin-dependent diabetic subjects . To date, aggressive antihypertensive treatment is the only intervention able to improve prognosis of these patients . The term diabetic nephropathy designates glomerular injury attributable to diabetes . 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].
KeywordsDiabetic Nephropathy Urinary Albumin Urinary Albumin Excretion Persistent Microalbuminuria Normotensive Type
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