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

  • Michel Marre
  • Patrick Fabbri
  • Gilles Berrut
  • Béatrice Bouhanick


Diabetic nephropathy is the main cause for premature death among type 1, insulin-dependent diabetic subjects [1J. To date, aggressive antihypertensive treatment is the main intervention along with better metabolic contact 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 as discussed elsewhere.


Diabetic Nephropathy Urinary Albumin Excretion Clinical Proteinuria Glomerular Dysfunction Persistent Microalbuminuria 
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Copyright information

© Springer Science+Business Media Dordrecht 1998

Authors and Affiliations

  • Michel Marre
    • 1
  • Patrick Fabbri
    • 1
  • Gilles Berrut
    • 1
  • Béatrice Bouhanick
    • 1
  1. 1.Unité de Diabétologie, Service de Médecine BCentre Hospitalier UniversitaireAngersFrance

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