Kongreß pp 194-194 | Cite as


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


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.

Stages in diabetic renal disease






Albumin excretion

Albumin excretion at exercise

Blood Pressure



Nephromegaly and hyperfunction


At diagnosis and when controlled imperfect




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




Incipient nephropathy

Early phase

After 10–20 years, but wide range

20–70 µ/min

Aggravation of baseline abnormalities



Late Phase

Few years later


70–250 µ/min

Aggravation of baseline abnormalities




Early Phase



Clinial proteinuria

Not studied


Over nephropathy

Intermediate phase

Few years after stage III



Late phase



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

Personalised recommendations