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Kongreß pp 194-194 | Cite as

Nephropathien

  • J. S. Christiansen
Conference paper
Part of the Verhandlungen der Deutschen Gesellschaft für Innere Medizin book series (VDGINNERE, volume 93)

Abstract

It is now firmly established that overt diabetic nephropathy, as evidenced by proteinuria, is associated with a profound overmortality both from uraemia and cardiovascular disease in general, whereas diabetics without proteinuria show a much smaller increase in mortality. Such studies emphasize the need for the early detection of renal disorders in diabetes, overt nephropathy with clinical proteinuria being a late finding. New follow-up studies and concepts have led to a definition of incipient diabetic nephropathy, the forerunner of overt diabetic nephropathy. Instead of “incipient diabetic nephropathy” the term “at risk for nephropathy patients” has also been proposed (Table). Patients with incipient nephropathy, as characterized by persisting microalbuminuria, also show elevation in blood pressure and in some cases glomerular hyperfiltration. They show more advanced retinopathy, and a high transcapillary escape rate of albumin. A review will be given on the relevance of these new concepts in relationship to pathogenesis of diabetic nephropathy and the clinical management of insulin-dependent diabetic patients. New longitudinal studies have show that rate of progression in diabetic patients with incipient diabetic nephropathy can be reversed by effective antihypertensive treatment. Also optimized insulin treatment, e.g. by insulin-pump seems to have a beneficial effect of the longterm outcome in these patiehts.
Table.

Stages in diabetic renal disease

Stages

Characterisitics

 

Chronology

GFR

Albumin excretion

Albumin excretion at exercise

Blood Pressure

       

I

Nephromegaly and hyperfunction

 

At diagnosis and when controlled imperfect

Normal

       

II

Glomerular lesions without clinical signs of disease

 

After two years of diabtes and progressive therafter

↑(⇈)

Normal at baseline

May increase, especially during poor metabolic control

Normal

       

III

Incipient nephropathy

Early phase

After 10–20 years, but wide range

20–70 µ/min

Aggravation of baseline abnormalities

n↑

       
  

Late Phase

Few years later

↑n

70–250 µ/min

Aggravation of baseline abnormalities

       

IV

 

Early Phase

 

n↓

Clinial proteinuria

Not studied

       
 

Over nephropathy

Intermediate phase

Few years after stage III

  

       
  

Late phase

 

n⇊

Proteinuria declining due to closure nephron

 

       

Copyright information

© J. F. Bergmann Verlag, München 1987

Authors and Affiliations

  • J. S. Christiansen
    • 1
  1. 1.2. University Clinic of Internal MedicineKommune Hospitalet AarhusDenmark

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