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Diabetic Nephropathy: Scope of the Problem

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Book cover Diabetes and Kidney Disease

Abstract

Diabetic nephropathy is a common complication of diabetes and the leading cause of chronic kidney disease in the developed world. Approximately 40 % of persons with type 2 diabetes develop diabetic nephropathy (albuminuria and/or decreased glomerular filtration rate). Even mild degrees of albuminuria and decrease in glomerular filtration rate are associated with significantly increased risks of cardiovascular disease, end-stage renal disease, and premature deaths. The prevalence of diabetic nephropathy in the US adult population aged 20 years and older is 3.3 % and increases with age (10.7 % among individuals aged 65 years and older). Increase in the prevalence of diabetic nephropathy is directly related to the increased prevalence of diabetes, which is largely driven by increasing obesity and metabolic syndrome. Both obesity and metabolic syndrome can directly contribute to the progression of kidney disease. These disorders likely interact with diabetes to exacerbate the kidney damage. In addition, increases in diabetic nephropathy prevalence are the largest for persons aged 65 years or older among whom diabetic nephropathy is most common. The prevention and treatment of diabetic nephropathy in older patients may require specific strategies. This chapter reviews the epidemiology of diabetic nephropathy, interrelationship between obesity, metabolic syndrome and diabetic nephropathy, and special challenges of diabetic nephropathy in the elderly.

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References

  1. Whiting D, Guariguata L, Weil C, et al. IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract. 2011;94:311–21.

    Article  PubMed  Google Scholar 

  2. Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. US Department of Health and Human Services. Atlanta, GA: Centers for Disease Control and Prevention; 2011.

    Google Scholar 

  3. de Boer IH, Rue TC, Hall YN, Heagerty PJ, Weiss NS, Himmelfarb J. Temporal trends in the prevalence of diabetic kidney disease in the United States. JAMA. 2011;305(24):2532–9.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Parving H, Lewis J, Ravid M, et al. Prevalence and risk factors for microalbuminuria in a referred cohort of type II diabetic patients: a global perspective. Kidney Int. 2006;69:2057–63.

    Article  PubMed  Google Scholar 

  5. Unnikrishnan R, Rema M, Pradeepa R, et al. Prevalence and risk factors of diabetic nephropathy in an urban South Indian population: the Chennai Urban Rural Epidemiology Study (CURES 45). Diabetes Care. 2007;30:2019–24.

    Article  CAS  PubMed  Google Scholar 

  6. Yokoyama H, Sone H, Oishi M, Kawai K, Fukumoto Y, Kobayashi M. Japan Diabetes Clinical Data Management Study Group. Prevalence of albuminuria and renal insufficiency and associated clinical factors in type 2 diabetes: the Japan Diabetes Clinical Data Management study (JDDM15). Nephrol Dial Transplant. 2009;24(4):1212–9.

    Article  CAS  PubMed  Google Scholar 

  7. Young B, Katon W, Von Korff M, et al. Racial and ethnic differences in microalbuminuria prevalence in a diabetes population: the pathways study. J Am Soc Nephrol. 2005;16:219–28.

    Article  PubMed  Google Scholar 

  8. US Renal Data System. USRDS 2012 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Bethesda, MD; 2012.

    Google Scholar 

  9. Hill CJ, Fogarty DG. Changing trends in end-stage renal disease due to diabetes in the United Kingdom. J Ren Care. 2012;38 Suppl 1:12–22.

    Article  PubMed  Google Scholar 

  10. Grace B, Clayton P, McDonald S. Increases in renal replacement therapy in Australia and New Zealand: understanding trends in diabetic nephropathy. Nephrology (Carlton). 2012;17:76–84.

    Article  Google Scholar 

  11. Deloitte Access Economics. Two of a KinD (Kidneys in Diabetes): the burden of diabetic kidney disease and the cost effectiveness of screening people with type 2 diabetes for chronic kidney disease. Kidney Health Australia. Melbourne, VIC: Kidney Health Australia; 2011.

    Google Scholar 

  12. Nichols G, Vupputuri S, Lau H. Medical care costs associated with progression of diabetic nephropathy. Diabetes Care. 2011;34:2374–8.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA. 2006;295:1549–55.

    Article  CAS  PubMed  Google Scholar 

  14. Hall JE, Jones DW, Kuo JJ, da Silva A, Tallam LS, Liu J. Impact of the obesity epidemic on hypertension and renal disease. Curr Hypertens Rep. 2003;5:386–92.

    Article  PubMed  Google Scholar 

  15. Neter JE, Stam BE, Kok FJ, Grobbee DE, Geleijnse JM. Influence of weight reduction on blood pressure: a meta-analysis of randomized controlled trials. Hypertension. 2003;42:878–84.

    Article  CAS  PubMed  Google Scholar 

  16. Garrison RJ, Kannel WB, Stokes III J, Castelli WP. Incidence and precursors of hypertension in young adults: the Framingham Offspring Study. Prev Med. 1987;16:235–51.

    Article  CAS  PubMed  Google Scholar 

  17. Maric-Bilkan C. Obesity and diabetic kidney disease. Med Clin North Am. 2013;97(1):59–74.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Hall JE, Henegar JR, Dwyer TM, Liu J, Da Silva AA, Kuo JJ, Tallam L. Is obesity a major cause of chronic kidney disease? Adv Ren Replace Ther. 2004;11:41–54.

    Article  PubMed  Google Scholar 

  19. Henegar JR, Bigler SA, Henegar LK, Tyagi SC, Hall JE. Functional and structural changes in the kidney in the early stages of obesity. J Am Soc Nephrol. 2001;12:1211–7.

    CAS  PubMed  Google Scholar 

  20. Yip JW, Jones SL, Wiseman MJ, Hill C, Viberti G. Glomerular hyperfiltration in the prediction of nephropathy in IDDM: a 10-year follow-up study. Diabetes. 1996;45:1729–33.

    Article  CAS  PubMed  Google Scholar 

  21. Van Buren PN, Toto R. Hypertension in diabetic nephropathy: epidemiology, mechanisms, and management. Adv Chronic Kidney Dis. 2011;18:28–41.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Mancia G. Effects of intensive blood pressure control in the management of patients with type 2 diabetes mellitus in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. Circulation. 2010;122:847–9.

    Article  PubMed  Google Scholar 

  23. Chagnac A, Weinstein T, Herman M, Hirsh J, Gafter U, Ori Y. The effects of weight loss on renal function in patients with severe obesity. J Am Soc Nephrol. 2003;14:1480–6.

    Article  PubMed  Google Scholar 

  24. Hall JE. The kidney, hypertension, and obesity. Hypertension. 2003;41:625–33.

    Article  PubMed  Google Scholar 

  25. Griffin KA, Kramer H, Bidani AK. Adverse renal consequences of obesity. Am J Physiol Renal Physiol. 2008;294:F685–96.

    Article  CAS  PubMed  Google Scholar 

  26. Vallon V, Schroth J, Satriano J, Blantz RC, Thomson SC, Rieg T. Adenosine A(1) receptors determine glomerular hyperfiltration and the salt paradox in early streptozotocin diabetes mellitus. Nephron Physiol. 2009;111:30–8.

    Article  Google Scholar 

  27. Woods LL, Mizelle HL, Hall JE. Control of renal hemodynamics in hyperglycemia: possible role of tubuloglomerular feedback. Am J Physiol. 1987;252:F65–73.

    CAS  PubMed  Google Scholar 

  28. Persson P, Hansell P, Palm F. Tubular reabsorption and diabetes-induced glomerular hyperfiltration. Acta Physiol (Oxf). 2010;200:3–10.

    CAS  PubMed Central  PubMed  Google Scholar 

  29. Cherney DZ, Scholey JW, Miller JA. Insights into the regulation of renal hemodynamic function in diabetic mellitus. Curr Diabetes Rev. 2008;4:280–90.

    Article  CAS  PubMed  Google Scholar 

  30. Carmines PK. The renal vascular response to diabetes. Curr Opin Nephrol Hypertens. 2010;19:85–90.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  31. Jauregui A, Mintz DH, Mundel P, Fornoni A. Role of altered insulin signaling pathways in the pathogenesis of podocyte malfunction and microalbuminuria. Curr Opin Nephrol Hypertens. 2009;18:539–45.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  32. do Carmo JM, Tallam LS, Roberts JV, Brandon EL, Biglane J, da Silva AA, Hall JE. Impact of obesity on renal structure and function in the presence and absence of hypertension: evidence from melanocortin-4 receptor-deficient mice. Am J Physiol Regul Integr Comp Physiol. 2009;297:R803–12.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  33. Fried LF, Orchard TJ, Kasiske BL. Effect of lipid reduction on the progression of renal disease: a meta-analysis. Kidney Int. 2001;59:260–9.

    Article  CAS  PubMed  Google Scholar 

  34. Jauregui A, Mintz DH, Mundel P, Fornoni A. Role of altered insulin signaling pathways in the pathogenesis of podocyte malfunction and microalbuminuria. Curr Opin Nephrol Hypertens. 2009;18:539–45.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  35. de Boer IH, Sibley SD, Kestenbaum B, Sampson JN, Young B, Cleary PA, Steffes MW, Weiss NS, Brunzell JD. Central obesity, incident microalbuminuria, and change in creatinine clearance in the epidemiology of diabetes interventions and complications study. J Am Soc Nephrol. 2007;18:235–43.

    Article  PubMed Central  PubMed  Google Scholar 

  36. Comper WD, Russo LM. The glomerular filter: an imperfect barrier is required for perfect renal function. Curr Opin Nephrol Hypertens. 2009;18:336–42.

    Article  CAS  PubMed  Google Scholar 

  37. Rutledge JC, Ng KF, Aung HH, Wilson DW. Role of triglyceride-rich lipoproteins in diabetic nephropathy. Nat Rev Nephrol. 2010;6:361–70.

    Article  CAS  PubMed  Google Scholar 

  38. King GL. The role of inflammatory cytokines in diabetes and its complications. J Periodontol. 2008;79:1527–34.

    Article  CAS  PubMed  Google Scholar 

  39. Ziyadeh FN. Mediators of diabetic renal disease: the case for tgf-Beta as the major mediator. J Am Soc Nephrol. 2004;15:S55–7.

    Article  CAS  PubMed  Google Scholar 

  40. McDonald M, Hertz RP, Unger AN, et al. Prevalence, awareness, and management of hypertension, dyslipidemia, and diabetes among United States adults aged 65 and older. J Gerontol A Biol Sci Med Sci. 2009;64(2):256–63.

    Article  PubMed  Google Scholar 

  41. Coresh J, Selvin E, Stevens LA, et al. Prevalence of chronic kidney disease in the United States. JAMA. 2007;298(17):2038–47.

    Article  CAS  PubMed  Google Scholar 

  42. United States Renal Data System. USRDS 2008 annual data report. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2008.

    Google Scholar 

  43. Patel UD, Young EW, Ojo AO, et al. CKD progression and mortality among older patients with diabetes. Am J Kidney Dis. 2005;46(3):406–14.

    Article  PubMed  Google Scholar 

  44. Abaterusso C, Lupo A, Ortalda V, et al. Treating elderly people with diabetes and stages 3 and 4 chronic kidney disease. Clin J Am Soc Nephrol. 2008;3:1185–94.

    Article  PubMed  Google Scholar 

  45. Sugarman JR, Reiber GE, Baumgardner G, et al. Use of therapeutic footwear benefit among diabetic medicare beneficiaries in three states, 1995. Diabetes Care. 1998;21:777–81.

    Article  CAS  PubMed  Google Scholar 

  46. American Diabetes Association. Economic costs of diabetes in the U.S. in 2007. Diabetes Care. 2008;31(3):596–615.

    Article  Google Scholar 

  47. Zhou XJ, Laszik ZG, Silva FG. Anatomical changes in the aging kidney. In: Macias-Nunez JF, Cameron JS, Oreopoulos DG, editors. The aging kidney in health and disease. New York: Springer; 2007. p. 39–54.

    Google Scholar 

  48. Nadasdy T, Laszik ZG, Blick KE. Tubular atrophy in the end-stage kidney: a lectin and immunohistochemical study. Hum Pathol. 1994;25:22–8.

    Article  CAS  PubMed  Google Scholar 

  49. Sawicki P, Kaiser S, Heinemann L, et al. Prevalence of renal artery stenosis in diabetes mellitus: an autopsy study. J Intern Med. 1991;229:489–92.

    Article  CAS  PubMed  Google Scholar 

  50. Brown SF, Mangione CM, Saliba D, et al. California Healthcare Foundation/American Geriatrics Society Panel Improving Care for Elders with Diabetes. Guidelines for improving the care of older persons with diabetes mellitus. J Am Geriatr Soc. 2003;51 Suppl 5:S265–80.

    PubMed  Google Scholar 

  51. Wenger NS, Shekelle PG, Roth CP. The ACOVE investigators: introduction to the assessing care of vulnerable elders-3 quality indicator measurement set. J Am Geriatr Soc. 2007;55 Suppl 2:S247–52.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, SL45, New Orleans, LA, USA

    Jing Chen M.D., M.M.Sc., M.Sc.

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  1. Jing Chen M.D., M.M.Sc., M.Sc.
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Correspondence to Jing Chen M.D., M.M.Sc., M.Sc. .

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Editors and Affiliations

  1. University of Illinois, Chicago, Illinois, USA

    Edgar V. Lerma

  2. Nephrology Section, Tulane University Medical School, New Orleans, Louisiana, USA

    Vecihi Batuman

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Chen, J. (2014). Diabetic Nephropathy: Scope of the Problem. In: Lerma, E., Batuman, V. (eds) Diabetes and Kidney Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0793-9_2

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  • DOI: https://doi.org/10.1007/978-1-4939-0793-9_2

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  • Publisher Name: Springer, New York, NY

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