Renal Transplantation for Diabetic Nephropathy

  • Eli A. Friedman


Diabetes mellitus, in 1994, is the leading cause of end-stage renal disease (ESRD) in the United States (US), Japan, and most nations in industrialized Europe. All registries in Europe, Asia, and North America show that glomerulonephritis and hypertensive renal disease rank well below diabetes in frequency of diagnosis among new ESRD patients, substantiating Mauer and Chavers contention that »Diabetes is the most important cause of ESRD in the Western world [1]«. The growth of both the total and diabetic population of ESRD patients in the US is depicted in figure 47–1. Data from 1990, the most recent calendar year report of the United States Renal Data System (USRDS), underscore this point. Of 165,363 patients — including 40,174 with diabetes (24.3%) — receiving either dialytic therapy or a kidney transplant in the US in 1990 – 45,153 developed ESRD during 1990 [2]. There were 15,383 (34.0%) diabetics whose renal failure was attributed to diabetes in the new incidence group. Therefore, while the incidence of ESRD caused by diabetes is 62 per million out of a total for all diseases of 169 per million, the prevalence of diabetics among those undergoing ESRD treatment decreased to a smaller segment of the whole (152 per million out of a total of 618 per million).


Diabetes Type Diabetic Nephropathy Renal Transplantation Kidney Transplant ESRD Patient 
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  1. 1.
    Mauer SM, Chavers BM. A comparison of kidney disease in type I and type II diabetes. Adv Exp Med Biol 1985; 189: 299–303.PubMedGoogle Scholar
  2. 2.
    U.S. Renal Data System. USRDS 1993 Annual Data Report. Bethesda MD: The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 1993; March.Google Scholar
  3. 3.
    Ghavamian M, Gutch CF, Kopp KF, Kolff WJ. The sad truth about haemodialysis in diabetic nephropathy. JAMA 1972; 222: 1386–1389.PubMedCrossRefGoogle Scholar
  4. 4.
    Lemmer ER, Swanepoel CR, Kahn D, van-Zyl-Smit R. Transplantation for diabetic nephropathy at Groote Schuur Hospital. S Afr Med J 1993; 83: 88–90.PubMedGoogle Scholar
  5. 5.
    Basadonna G, Matas AJ, Gillingham K, Sutherland DE, Payne WD, Dunn DI, Gores PF, Gruessner RW, Arrazola I, Najarían JS. Kidney transplantation in patients with type I diabetes: 26-year experience at the University of Minnesota. In Terasaki PI, Cecka JM (eds). Clinical Transplants 1992. Los Angeles, CA: UCLA Tissue Typing Laboratory; 1993; pp 227–235.Google Scholar
  6. 6.
    Lowder GM, Perri NA, Friedman EA. Demographics, diabetes type, and degree of rehabilitation in diabetic patients on maintenance haemodialysis in Brooklyn. J Diabetic Complications 1988; 2: 218–226.CrossRefGoogle Scholar
  7. 7.
    Nagai N. Clinical statistics of 551 patients with diabetes mellitus found before 30 years of age. J Tokyo Worn Med Coll 1982; 52: 904–915.Google Scholar
  8. 8.
    Mogensen CE, Christensen CK, Vittinghus E. The stages in diabetic renal disease with emphasis on the stage of incipient diabetic nephropathy. Diabetes 1983; 32: suppl. 2: 64–78.Google Scholar
  9. 9.
    Christensen CK, Christiansen JS, Schmitz A, Christensen T, Hermansen K, Mogensen CE. Effect of continuous subcutaneous insulin infusion on kidney function and size in IDDM patients. A 2 year controlled study. J Diabetic Complications 1987; 1: 91–95.CrossRefGoogle Scholar
  10. 10.
    Mogensen CE. Angiotensin converting enzyme inhibitors and diabetic nephropathy. BMJ 1992; 304: 327–328.PubMedCrossRefGoogle Scholar
  11. 11.
    Balodimus MC. Diabetic nephropathy. In Marble A, White P, Bradley RF, Krall LP (eds). Joslin’s Diabetes. Philadelphia: Lea and Febiger; 1971; pp 526–561.Google Scholar
  12. 12.
    Grenfell A, Watkins PJ. Clinical diabetic nephropathy: natural history and complications. Clin Endocr Metab 1986; 15: 783–805.CrossRefGoogle Scholar
  13. 13.
    Humphrey LL, Ballard DJ, Frohnert PP, Chu CP, O’Fallon WM, Palumbo PJ. Chronic renal Failure in non-insulin-dependent diabetes mellitus. Ann Intern Med 1989; 10: 788–796.CrossRefGoogle Scholar
  14. 14.
    Hasslacher CH, Ritz E, Wahl P, Michael C. Similar risks of nephropathy in patients with type I or type II diabetes mellitus. Nephrol Dial Transplant 1989; 4: 859–863.PubMedGoogle Scholar
  15. 15.
    Neu S, Kjellstrand CM. Stopping long-term dialysis. An empirical study of withdrawal of life-supporting treatment. N Engl J Med 1986; 314: 14–20.PubMedCrossRefGoogle Scholar
  16. 16.
    Khauli RB, Steinmuller DR, Novick AC, et al. A critical look at survival of diabetics with end-stage renal disease: transplantation versus dialysis therapy. Transplantation 1986; 41: 598–602.PubMedCrossRefGoogle Scholar
  17. 17.
    Rettig RA, Levinsky NG (ed). Kidney Failure and the Federal Government Access to Kidney Transplantation. Institute for Medicine (U.S.). National Academy of Sciences; 1991; pp 167–186.Google Scholar
  18. 18.
    Cecka JM, Terasaki PI. The UNOS Scientific Renal Transplant Registry — 1991. In Terasaki PI (ed). Clinical Transplants 1991. Los Angeles CA: UCLA Tissue Typing Laboratory; 1992; pp 1–11.Google Scholar
  19. 19.
    Paterson AD, Dornan TL, Peacock I, et al. Cause of death in diabetic patients with impaired renal function. An audit of a hospital diabetic clinic population. Lancet 1987; 1: 313–316.PubMedCrossRefGoogle Scholar
  20. 20.
    Lewis EJ, Hunsicker LG, Bain RP, Rhode RD. The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. N Engl J Med 1993; 329: 1456–1462.PubMedCrossRefGoogle Scholar
  21. 21.
    Maryniak RK, Mendoza N, Clyne D, Balakrishnan K, Weiss MA. Recurrence of diabetic nodular glomerulosclerosis in a renal transplant. Transplantation 1985; 39: 35–38.PubMedCrossRefGoogle Scholar
  22. 22.
    Abouna G, Adnani MS, Kumar MS, Samhan SA. Fate of transplanted kidneys with diabetic nephropathy. Lancet 1986; 1: 622–624.PubMedCrossRefGoogle Scholar
  23. 23.
    Tuttle KR, Bruton L, Perusek MC, Lancaster JL, Kopp DT, DeFronzo R. Effect of strict glycemic control on renal hemodynamic response to amino acids and renal enlargement in insulin-dependent in insulin-dependent diabetes mellitus. N Engl J Med 1991; 324: 1626–1632.PubMedCrossRefGoogle Scholar
  24. 24.
    Brownlee M. Glycosylation of proteins and microangiopathy. Hosp Pract (Off) 1992; 27: suppl. 1: 46–50.Google Scholar
  25. 25.
    Vlassara H, Fuh H, Makita Z, Krungkrai S, Cerami A, Cucala R. Exogenous advanced glycosylation end products induce complex vascular dysfunction in normal animals: a model for diabetic and aging complications. Proc Natl Acad Sci USA 1992; 89: 12043–12047.PubMedCrossRefGoogle Scholar
  26. 26.
    Makita Z, Radoff S, Rayfield EJ, Yang Z, Skolnik E, Delaney V, Friedman EA, Cerami A, Vlassara H. Advanced glycosylation end products in patients with diabetic nephropathy. New Engl J Med 1991; 325: 836–842.PubMedCrossRefGoogle Scholar
  27. 27.
    Ellis EN, Good BH. Prevention of glomerular basement membrane thickening by aminoguanidine in experimental diabetes mellitus. Metabolism 1991; 40: 1016–1019.PubMedCrossRefGoogle Scholar
  28. 28.
    Hammes HP, Martin S, Federlin K, Geisen K, Brownlee M. Aminoguanidine treatment inhibits the development of experimental diabetic retinopathy. Proc Natl Acad Sci USA 1991; 88: 11555–11558.PubMedCrossRefGoogle Scholar
  29. 29.
    Yagihashi S, Kamijo M, Baba M, Yagihashi M, Nagai K. Effect of aminoguanidine on functional and structural abnormalities in peripheral nerve of STZ-induced diabetic rats. Diabetes 1992; 41: 47–52.PubMedCrossRefGoogle Scholar
  30. 30.
    Brownlee M. Pharmacological modulation of the advanced glycosylation reaction. Prog Clin Biol Res 1989; 304: 235–248.PubMedGoogle Scholar
  31. 31.
    Nicholls K, Mandel TE. Advanced glycosylation end-products in experimental murine diabetic nephropathy: effect of islet isografting and of aminoguanidine. Lab Invest 1989; 60: 486–491.PubMedGoogle Scholar
  32. 32.
    Lyons TJ, Dailie KE, Dyer DG, Dunn JA, Baynes JW. Decrease in skin collagen glycation with improved glycemic control in patients with insulin-dependent diabetes mellitus. J Clin Invest 1991; 87: 1910–1915.PubMedCrossRefGoogle Scholar
  33. 33.
    Corbett JA, Tilton RG, Chang K, Hasan KS, Ido Y, Wang JL, Sweetland MA, Lancaster Jr, Williamson JR, McDaniel ML. Aminoguanidine, a novel inhibitor of nitric oxide formation, prevents diabetic vascular dysfunction. Diabetes 1992; 4: 552–556.CrossRefGoogle Scholar
  34. 34.
    Tilton RG, Chang K, Hasan KS, Smith SR, Petrash JM, Misko TP, Moore WM, Currie MG, Corbett JA, McDaniel ML, et al. Prevention of diabetic vascular dysfunction by guanidines. Inhibition of nitric oxide synthase versus advanced glycation end-product formation. Diabetes 1993; 42: 221–232.PubMedCrossRefGoogle Scholar
  35. 35.
    Sensi M, Pricci F, Andreani D, DiMario U. Advanced nonenzymatic glycation endproducts (AGE): their relevance to aging and the pathogenesis of late diabetic complications. Diabetes Res 1991; 16: 1–9.PubMedGoogle Scholar
  36. 36.
    Edelstein D, Brownlee M. Mechanistic studies of advanced glycosylation end product inhibition by aminoguanidine. Diabetes 1992; 41: 26–29.PubMedCrossRefGoogle Scholar
  37. 37.
    Eika B, Levin RM, Longhurst PA. Collagen and bladder function in streptozotocin-diabetic rats: effects of insulin and aminoguanidine. J Urol 1992; 148: 167–172.PubMedGoogle Scholar
  38. 38.
    Braun WE, Phillips D, Vidt DG, et al. The course of coronary artery disease in diabetics with and without renal allografts. Transplant Proc 1983; 15: 1114–1119.Google Scholar
  39. 39.
    Khauli RB, Steinmuller DR, Novick AC, et al. A critical look at survival of diabetics with end-stage renal disease: transplantation versus dialysis therapy. Transplantation 1986; 41: 598–602.PubMedCrossRefGoogle Scholar
  40. 40.
    Philipson JD, Carpenter BJ, Itzkoff J, HakalaTR, Rosenthal JT, Taylor RJ, PuschettJB. Evaluation of cardiovascular risk for renal transplantation in diabetic patients. Am J Med 1986. 81: 630–634.PubMedCrossRefGoogle Scholar
  41. 41.
    Corry RJ, Nghiem DD, SchanbacherB, et al. Critical analysis of mortality and graft loss following simultaneous renal- pancreatic duodenal transplantation. Transplant Proc 1987; 19: 2305–2306.PubMedGoogle Scholar
  42. 42.
    Gill JB, Ruddy TD, Newell JB, et al. Prognostic importance of thallium uptake by the lungs during exercise in coronary artery disease. N Engl J Med 1987; 317: 1485–1489.CrossRefGoogle Scholar
  43. 43.
    Fanning WJ, Henry ML, Sommer BG, et al. Lower extremity and renal ischemia following renal transplantation. Vascular Surg 1986; 23: 231–234.CrossRefGoogle Scholar
  44. 44.
    Abendroth D, Landgraft R, Illner WD, et al. Beneficial effects of pancreatic transplantation in insulin-dependent diabetes mellitus patients. Transplant Proc 1990; 22: 696–697.PubMedGoogle Scholar
  45. 45.
    Gonzalez-Carrillo M, Moloney A, Bewick M, et al. Renal transplantation in diabetic nephropathy. BMJ 1982; 285: 1713–1716.PubMedCrossRefGoogle Scholar
  46. 46.
    Yuge J, Cecka JM. Sex and age effects in renal transplantation. In Terasaki PI (ed). Clinical Transplants 1991. Los Angeles, CA: UCLA Tissue Typing Laboratory; 1992; pp 261.Google Scholar
  47. 47.
    Najarian JS, Sutherland DER, Simmons RL, et al. Ten Year Experience with Renal Transplantation in Juvenile Onset Diabetics. Ann Surg 1979; 190: 487–500.PubMedCrossRefGoogle Scholar
  48. 48.
    Østerby R, Nyberg G, Hedman L, Karlberg I, Persson H, Svalander C. Kidney transplantation in type 1 (insulin-dependent) diabetic patients. Diabetologia 1991;9: 668–674.CrossRefGoogle Scholar
  49. 49.
    Bohman SO, Wilczek H, Jaremko G, et al. Recurrence of diabetic nephropathy in human renal allografts: Preliminary report of a biopsy study. Transplant Proc 1984; 16: 649–653.PubMedGoogle Scholar
  50. 50.
    Mauer SM, Goetz FC, McHugh LE, et al. Long-term study of normal kidneys transplanted into patients with type I diabetes. Diabetes 1989; 38: 516–523.PubMedCrossRefGoogle Scholar
  51. 51.
    Najarian JS, Kaufman DB, Fryd DS, McHugh L, Mauer SM, Ramsay RC, Kennedy WR, Navarro X, Goetz FC, Sutherland DE. Long-term survival following kidney transplantation in 100 type 1 diabetic patients. Transplantation 1989; 1: 106–113.CrossRefGoogle Scholar
  52. 52.
    Remuzzi G, Ruggenenti P, Mauer SM. Pancreas and kidney/pancreas transplants: experimental medicine or real improvement? Lancet 1994; 343: 27–31.PubMedCrossRefGoogle Scholar
  53. 53.
    Shapiro R, Jordan ML, Scantlebury VP, Fung JJ, Jensen C, Vivas C, McCauley J, Irish WD, Mitchell S, Demetrias AJ et al. Randomized trial of FK 506/prednisone vs FK 50–6/azathioprine/prednisoneafter renal transplantation: preliminary report. Transplant Proc 1993; 25: 669–672.PubMedGoogle Scholar

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© Springer Science+Business Media New York 1994

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  • Eli A. Friedman

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