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Managing Diabetic Nephropathies in Clinical Practice pp 23–45Cite as

Pathogenesis of Diabetic Nephropathy

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Abstract

Diabetic nephropathy (DN), also known as diabetic kidney disease (DKD), is a major microvascular complication of diabetes mellitus. Traditionally, it has been identified as a triad of albuminuria, hypertension, and declining renal function in patients with diabetes mellitus. Earlier estimates suggested that nephropathy affects 30 % of patients with type 1 diabetes and 20 % of patients with type 2 diabetes. Prevalence of DN is a function of the duration of diabetes. Although recent estimates suggest a decline in the incidence among those with type 1 diabetes, DN remains a serious threat to overall survival in patients with diabetes mellitus [1]. It must, however, be noted that with improved blood pressure control and renal replacement therapy, the outlook has vastly changed, with a reported 10-year survival rate of 82 % as against a corresponding figure of 28 % in those with persistent albuminuria reported only three decades ago [2]. The utility of microalbuminuria in determining progression and prognosis is complicated by 10 % of patients with DN not having proteinuria, day-to-day variation in albumin excretion rate, regression to mean over longitudinal follow-up, and failure to demonstrate microalbuminuria as a therapeutic target in prevention of overt diabetic nephropathy in type 1 diabetic patients subjected to intensified glycemic control.

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Authors and Affiliations

  1. Division of Nephrology, Eastern Virginia Medical School, Norfolk, VA, USA

    Liwei Huang

  2. East Virginia Medical School, Norfolk, Virginia, USA

    Romesh Khardori

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Huang, L., Khardori, R. (2017). Pathogenesis of Diabetic Nephropathy. In: Managing Diabetic Nephropathies in Clinical Practice. Adis, Cham. https://doi.org/10.1007/978-3-319-08873-0_2

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  • DOI: https://doi.org/10.1007/978-3-319-08873-0_2

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