Der Diabetologe

, Volume 5, Issue 3, pp 190–199 | Cite as

Diabetes und Niere – Update 2009



Die Nephropathie bestimmt wesentlich die Prognose der Erkrankung Diabetes mellitus. Neue Erkenntnisse haben zum besseren Verständnis der komplexen Pathophysiologie der diabetischen Nephropathie beigetragen. Nach aktuellen Studienergebnissen haben Patienten mit diabetischer Nephropathie in allen Stadien der Erkrankung deutliche Vorteile von einer intensiven multifaktoriellen antidiabetischen, antihypertensiven und lipidmodifizierenden Therapie. Die vorliegende Übersicht geht auf neue Daten der letzten 2 Jahre ein.


Diabetische Nephropathie Neue Studien Antihypertensive Therapie Antiglykämische Therapie 

Diabetes and the kidney


Renal involvement is an important prognostic predictor in diabetes mellitus. Novel perceptions regarding the complex pathophysiology of diabetic nephropathy have improved our understanding of this disease. Recent studies indicate that patients with diabetes profit at all stages of the disease from an intensive therapeutic approach involving the control of hypertension, blood glucose, and dyslipidemia. The current overview focuses on data published in the last 2 years.


Diabetic nephropathy New studies Antihypertensive therapy Antiglycemic therapy 


  1. 1.
    ADVANCE Collaborative Group, Patel A, MacMahon S et al (2008) Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 358:2560–2572CrossRefGoogle Scholar
  2. 2.
    Astrup AS, Tarnow L, Pietraszek L et al (2008) Markers of endothelial dysfunction and inflammation in type 1 diabetic patients with or without diabetic nephropathy followed for 10 years: association with mortality and decline of glomerular filtration rate. Diabetes Care 31:1170–1176PubMedCrossRefGoogle Scholar
  3. 3.
    Bakris G, Burgess E, Weir M et al (2008) Telmisartan is more effective than losartan in reducing proteinuria in patients with diabetic nephropathy. Kidney Int 74:364–369PubMedCrossRefGoogle Scholar
  4. 4.
    Brantsma AH, Bakker SJ, Zeeuw D de et al (2008) PREVEND Study Group: Extended prognostic value of urinary albumin excretion for cardiovascular events. J Am Soc Nephrol 19:1785–1791PubMedCrossRefGoogle Scholar
  5. 5.
    Gaede P, Lund-Andersen H, Parving HH, Pedersen O (2008) Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med 358:580–591PubMedCrossRefGoogle Scholar
  6. 6.
    Galle J, Schwedhelm E, Pinnetti S et al (2008) Antiproteinuric effects of angiotensin receptor blockers: telmisartan versus valsartan in hypertensive patients with type 2 diabetes mellitus and overt nephropathy. Nephrol Dial Transplant 23:3174–3183PubMedCrossRefGoogle Scholar
  7. 7.
    Görlitz N, Keller M, Ziegler AG (2008) Prävalenzen von Folge- und Begleiterkrankungen des Typ-2-Diabetes. Querschnittsuntersuchung an DMP-Teilnehmern in Bayern. Dtsch Med Wochenschr 133:1667–1672PubMedCrossRefGoogle Scholar
  8. 8.
    Grauslund J, Green A, Sjølie AK (2008) Proliferative retinopathy and proteinuria predict mortality rate in type 1 diabetic patients from Fyn County, Denmark. Diabetologia 51:583–588PubMedCrossRefGoogle Scholar
  9. 9.
    Hadjadj S, Fumeron F, Roussel R et al (2008) Prognostic value of the insertion/deletion polymorphism of the ACE gene in type 2 diabetic subjects: results from the Non-insulin-dependent Diabetes, Hypertension, Microalbuminuria or Proteinuria, Cardiovascular Events, and Ramipril (DIABHYCAR), Diabete de type 2, Nephropathie et Genetique (DIAB2NEPHROGENE) and Survie, Diabete de type 2 et Genetique (SURDIAGENE) studies. Diabetes Care 31:1847–1852PubMedCrossRefGoogle Scholar
  10. 10.
    Hasslacher C, Kempe P, Wolf G (2007) Diabetische Nephropathie. Diabetologie 2 (Suppl 2):S159–S162CrossRefGoogle Scholar
  11. 11.
    Holman RR, Paul SK, Bethel MA et al (2008) Long-term follow-up after tight control of blood pressure in type 2 diabetes. N Engl J Med 359:1565–1576PubMedCrossRefGoogle Scholar
  12. 12.
    Holman RR, Paul SK, Bethel MA et al (2008) 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 359:1577–1589PubMedCrossRefGoogle Scholar
  13. 13.
    Hunger-Dathe W, Wolf G (2006) Albuminurie bei Diabetes mellitus. Marker und Ursache der diabetischen Nephropathie und vaskulärer Komplikationen. Diabetologie 2:400–409CrossRefGoogle Scholar
  14. 14.
    Isermann B, Vinnikov IA, Madhusudhan T et al (2007) Activated protein C protects against diabetic nephropathy by inhibiting endothelial and podocyte apoptosis. Nat Med 13:1284–1285CrossRefGoogle Scholar
  15. 15.
    Jorsal A, Tarnow L, Flyvbjerg A et al (2008) Plasma osteoprotegerin levels predict cardiovascular and all-cause mortality and deterioration of kidney function in type 1 diabetic patients with nephropathy. Diabetologia 51:2100–2107PubMedCrossRefGoogle Scholar
  16. 16.
    Karalliedde J, Gnudi L (2008) ACCORD and ADVANCE: a tale of two studies on the merits of glycaemic control in type 2 diabetic patients. Nephrol Dial Transplant 23:1796–1798PubMedCrossRefGoogle Scholar
  17. 17.
    Karalliedde J, Smith A, DeAngelis L et al (2008) Valsartan improves arterial stiffness in type 2 diabetes independently of blood pressure lowering. Hypertension 51:1617–1623PubMedCrossRefGoogle Scholar
  18. 18.
    Mann JF, Schmieder RE, McQueen M et al (2008) Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): a multicentre, randomised, double-blind, controlled trial. Lancet 372:547–553PubMedCrossRefGoogle Scholar
  19. 19.
    Matthaei S, Thienel F (2008) Therapie des Diabetes mellitus Typ 2. Multifaktorielle Therapie reduziert mikro- und makrovaskuläre Komplikationen. Cardiovasc 3:26–31Google Scholar
  20. 20.
    Mizuiri S, Hemmi H, Arita M et al (2008) Expression of ACE and ACE2 in individuals with diabetic kidney disease and healthy controls. Am J Kidney Dis 51:613–623PubMedCrossRefGoogle Scholar
  21. 21.
    Mohanram A, Zhang Z, Shahinfar S et al (2008) The effect of losartan on hemoglobin concentration and renal outcome in diabetic nephropathy of type 2 diabetes. Kidney Int 73:630–636PubMedCrossRefGoogle Scholar
  22. 22.
    ONTARGET Investigators, Yusuf S, Teo KK et al (2008) Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med 358:1547–1559CrossRefGoogle Scholar
  23. 23.
    Parving HH, Zeeuw D de, Cooper ME et al (2008) ACE gene polymorphism and losartan treatment in type 2 diabetic patients with nephropathy. J Am Soc Nephrol 19:771–779PubMedCrossRefGoogle Scholar
  24. 24.
    Parving HH, Persson F, Lewis JB et al (2008) Aliskiren combined with losartan in type 2 diabetes and nephropathy. N Engl J Med 358:2433–2446PubMedCrossRefGoogle Scholar
  25. 25.
    Patel A, MacMahon S, Chalmers J (2007) Effects of a fixed combination of peridopril and indapamide von macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet 370:829–840PubMedCrossRefGoogle Scholar
  26. 26.
    Ruggenenti P, Bettinaglio P, Pinares F, Remuzzi G (2008) Angiotensin converting enzyme insertion/deletion polymorphism and renoprotection in diabetic and nondiabetic nephropathies. Clin J Am Soc Nephrol 3:1511–1525PubMedCrossRefGoogle Scholar
  27. 27.
    Rüster C, Sämann A, Wolf G (2008) Nieren und Diabetes. Dtsch Med Wochenschr 133:1848–1852PubMedCrossRefGoogle Scholar
  28. 28.
    Rüster C, Wolf G (2006) Renin-angiotensin-aldosterone system and progression of renal disease. J Am Soc Nephrol 17:2985–2991PubMedCrossRefGoogle Scholar
  29. 29.
    Schelling JR, Abboud HE, Nicholas SB et al (2008) Genome-wide scan for estimated glomerular filtration rate in multi-ethnic diabetic populations: the Family Investigation of Nephropathy and Diabetes (FIND). Diabetes 57:235–243PubMedCrossRefGoogle Scholar
  30. 30.
    Schjoedt KJ, Astrup AS, Persson F et al (2009) Optimal dose of lisinopril for renoprotection in type 1 diabetic patients with diabetic nephropathy: a randomised crossover trial. Diabetologia 52:46–49PubMedCrossRefGoogle Scholar
  31. 31.
    Sharma K, Ramachandrarao S, Qiu G et al (2008) Adiponectin regulates albuminuria and podocyte function in mice. J Clin Invest 118:1645–1656PubMedGoogle Scholar
  32. 32.
    The Action to Control Cardiovacsular Risk in Diabetes Study Group (2008) Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 358:2545–2559CrossRefGoogle Scholar
  33. 33.
    Tong Z, Yang Z, Patel S et al (2008) Promoter polymorphism of the erythropoietin gene in severe diabetic eye and kidney complications. Proc Natl Acad U S A 105:6998–7003CrossRefGoogle Scholar
  34. 34.
    Wolf G, Muller N, Tschauner T, Muller UA (2006) Prevalence of renal insufficiency in the diabetes TUV of the Deutsche BKK. Med Klin 101:441–447CrossRefGoogle Scholar
  35. 35.
    Wolf G, Ritz E (2003) Diabetic nephropathy in type 2 diabetes prevention and patient management. J Am Soc Nephrol 14:1396–1405PubMedCrossRefGoogle Scholar
  36. 36.
    Wolf G, Chen S, Ziyadeh FN (2005) From the periphery of the glomerular capillary wall toward the center of disease: podocyte injury comes of age in diabetic nephropathy. Diabetes 54:1626–1634PubMedCrossRefGoogle Scholar
  37. 37.
    Wolkow PP, Niewczas MA, Perkins B et al (2008) Association of urinary inflammatory markers and renal decline in microalbuminuric type 1 diabetics. J Am Soc Nephrol 19:789–797PubMedCrossRefGoogle Scholar
  38. 38.
    Ziyadeh FN, Wolf G (2008) Pathogenesis oft he podocytopathy and proteinuria in diabetic glomerulopathy. Curr Diab Rev 4:39–45CrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag 2009

Authors and Affiliations

  1. 1.Klinik für Innere Medizin IIIFriedrich-Schiller-Universität JenaJenaDeutschland

Personalised recommendations