International Urology and Nephrology

, Volume 34, Issue 2, pp 257–264 | Cite as

Diabetic nephropathy-pathophysiology and management

  • Judy Tan Shumway
  • Steven R. Gambert


Diabetes mellitus is the leading cause ofend-stage renal disease in the United States. Between 1996 and 2001, the prevalence ofdiabetes in the Medicare population increasedby 31%. Patients with diabetes account forapproximately one-third of all cases ofend-stage renal disease (ESRD). This number isexpected to rise dramatically as a result ofthe growing incidence of diabetes and the agingpopulation. A major complication of diabetesincludes end-stage renal disease as a resultfrom diabetic nephropathy. The earliestclinical evidence that nephropathy exists isthe appearance of low, yet abnormal, levels ofalbumin in the urine, referred to asmicroalbuminuria. This can progress toproteinuria representing overt diabeticnephropathy. Prevention remains the best way toreduce mortality and maintain a high quality oflife in these individuals as recent clinicaltrials confirm that it is possible to not onlyslow down the progression of diabeticnephropathy, but even prevent it from becominga significant problem. This article reviewsthe pathogenesis, diagnostic screening, andtreatment strategies of diabetic nephropathy.

Diabetic complications Diabetic nephropathy Microalbuminuria 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Renal Data System. USRDS 2001 ASN Talk. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases, 2001. (Accessed May 19, 2002, at http://www.usrds. org/presentations.html)Google Scholar
  2. 2.
    Renal Data System. USRDS 2000 annual data report. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases, 2001.Google Scholar
  3. 3.
    United States Renal Data System. USRDS Annual Data Report. Bethesda, MD: National Institute of Health, National Institute of Diabetes and Digestive and Kidney Diseases, July 1994.Google Scholar
  4. 4.
    American Diabetes Association. Clinical practice recommendations 2001. Diabetes Care 2001; 24(suppl): S69–72.Google Scholar
  5. 5.
    Ibrahim H, Hostetter T. Diabetic nephropathy. J of Am Society of Nephrology 1997; 8(3): 487–493.Google Scholar
  6. 6.
    Klein R, Klein B, Moss S. Incidence of gross proteinuria in older-onset diabetes. Diabetes 1993; 42: 381–389.Google Scholar
  7. 7.
    Keane W. Proteinuria: Its clinical importance and role in progressive renal disease. Am J Kidney Diseases 2000; 35(4).Google Scholar
  8. 8.
    Drummond K, Mauer M. The Early Natural History of Nephropathy in Type 1 Diabetes. Diabetes 2002; 51: 1580–1587.Google Scholar
  9. 9.
    Ruggenenti P, Remuzzi G. Nephropathy of Type-2 diabetes mellitus. J Am Society of Nephrology 1998; 9(11): 2157–2169.Google Scholar
  10. 10.
    Bank N. Mechanisms of diabetic hyperfiltration. Kidney Int 1991; 40: 792.Google Scholar
  11. 11.
    Nelson DG, Bennett PH, Beck GJ et al. Development and progression of renal disease in Pima Indians with non-insulin dependent diabetes mellitus. N Engl J Med 1996; 335: 1636.Google Scholar
  12. 12.
    Remuzzi G, Ruggenenti P, Benigni A. Understanding the nature of renal disease progression. Kidney Int 1997; 51: 2–15.Google Scholar
  13. 13.
    Remuzzi G, Schieppati A, Ruggenenti P. Nephropathy in patients with Type 2 diabetes. N Engl J Med 2002; 346(15): 1145–1151.Google Scholar
  14. 14.
    Ruggenenti P, Remuzzi G. The diagnosis of renal involvement in non-insulin dependent diabetes mellitus. Curr Opin Nephrology Hypertension 1997; 6: 141–145.Google Scholar
  15. 15.
    The Diabetes Control and Complications Trial Research Group. Effect of intensive therapy on the development and progression of diabetic nephropathy in the diabetes control and complications trial. Kidney Int 1995; 47: 1703–1720.Google Scholar
  16. 16.
    Shichiri M. et al. Kumamoto study on optimal diabetes control in NIDDM. Diabetes Care 2000; 23(suppl2): B21–29.Google Scholar
  17. 17.
    Zeller K, Whittaker E, Sullivan L et al. Effect of restricting dietary protein on the progression of renal failure in patients with insulin-dependent diabetes mellitus. N Engl J Med 1991; 324: 78–84.Google Scholar
  18. 18.
    Ritz E, Ogata H, Orth SR. Smoking: a factor promoting onset and progression of diabetic nephropathy. Diabetes Metab 2000; 26(Supp l4): 54–63.Google Scholar
  19. 19.
    Heart Outcomes Prevention Evaluation Study Group. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus. Lancet 2000; 355: 253–259.Google Scholar
  20. 20.
    Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976; 16: 31–41.Google Scholar
  21. 21.
    Levey AS, Bosch JP, Lewis JB et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Ann Intern Med 1999; 130: 461–470.Google Scholar
  22. 22.
    Sica DA, Bakris GL. Type 2 diabetes: RENAAL and IDNT – emergence of new treatment options. J Clin Hypertension 2002; 4(1): 52–57.Google Scholar
  23. 23.
    Rossing K, Christensen PK, Jensen BR, Parving HH. Dual blockade of the renin-angiotensin system in diabetic nephropathy: a randomized double-blind crossover study. Diabetes Care 2002; 25(1): 95–100.Google Scholar

Copyright information

© Kluwer Academic Publishers 2002

Authors and Affiliations

  • Judy Tan Shumway
    • 1
  • Steven R. Gambert
    • 1
  1. 1.Johns Hopkins University School of Medicine and Sinai Hospital of BaltimoreBaltimoreUSA

Personalised recommendations