The Concept of Incipient Diabetic Nephropathy and Effect of Early Antihypertensive Intervention
Diabetic nephropathy is the main cause for premature death among type 1, insulin-dependent diabetic subjects . To date, aggressive antihypertensive treatment is the only intervention able to improve prognosis of these patients . The term diabetic nephropathy designates glomerular injury attributable to diabetes . As in all glomerular diseases, its diagnosis is based upon three functional abnormalities: proteinuria (mainly, albuminuria), elevated blood pressure, and reduced glomerular filtration rate. Technical improvements lead to early detection of glomerular dysfunction in type 1, insulin-dependent diabetic subjects: the first ones were sensitive assays for urinary albumin measurement [4,5]; also sensitive techniques to detect glomerular hyperfiltration early in the course of diabetic renal disease, and only recently automatic blood pressure monitoring to detect minimal blood pressure changes [6,7]. The concept of incipient diabetic nephropathy was validated by 4 follow-up studies of patients whose urinary albumin was measured serially with sensitive techniques [8–11]. These studies indicated that minimal increases in Urinary Albumin Excretion (UAE) (called microalbuminuria) can have a prognostic value. Therefore, the concept of incipient diabetic nephropathy is based upon the premise that persistent microalbuminuria can already indicate initial glomerular injury, and not only glomerular dysfunction.
KeywordsDiabetic Nephropathy Urinary Albumin Excretion Clinical Proteinuria Glomerular Dysfunction Persistent Microalbuminuria
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- 1.Andersen AR, Christiansen JS, Andersen JK, Kreiner S, Deckert T. Diabetic nephropathy in type 1 (insulin-dependent) diabetes: an epidemiological study. Diabetologia 1983; 2: 496–501.Google Scholar
- 3.Deckert T, Poulsen JE, Larsen M. Prognosis of diabetics with diabetes onset before the age of thirty-one. I-survival, causes of death and complications. Diabetologia 1978; 14: 363–370.Google Scholar
- 9.Parving H-H, Oxenbøll B, Svendsen PAA, Christiansen JS, Andersen AR. Early detection of patients at risk of developing diabetic nephropathy. A longitudinal study of urinary albumin excretion. Acta Endocrinol (Copenh) 1982; 100: 550–555.Google Scholar
- 19.Starling EH. Physiological factors involved in the causation of dropsy. Lancet 1896; i: 1405.Google Scholar
- 27.Laffel LBM, McGill JB, Gans DJ, on behalf of The North American Microalbuminuria Study Group. The beneficial effect of angiotensin converting enzyme inhibition with captopril on diabetic nephropathy in normotensive IDDM patients with microalbuminuria. Am J Med 1995; 99: 497–504.PubMedCrossRefGoogle Scholar
- 31.Christensen CK, Mogensen CE. Effect of antihypertensive treatment on progression of incipient diabetic nephropathy. Hypertension 1985; 7: Suppl II: 109–113.Google Scholar
- 47.Fabbri P, Bouhanick B, Freneau E, Vilayleck B, Berrut G, Fressinaud PH, Marre M. Comparison of two treatment strategies with angiotensin I converting enzyme inhibitors in normotensive IDDM patients with microalbuminuria (Abstract). DiabetesDiabetes 1995; 44: suppl. 1: 24A.Google Scholar
- 49.Azizi M, Rousseau A, Ezan E, Guyene TT, Michelet S, Grognet JM, Lenfant M, Corvol P, Menard J. Acute angiotensin-converting enzyme inhibition increases the plasma level of the natural stem cell regulator N-acetyl-seryl-aspartyl-lysyl-proline. J Clin Invest 1996; 97: 839–844.PubMedCentralPubMedCrossRefGoogle Scholar
- 53.The Euclid Study Group. The effect of Lisinopril on albumin excretion rate in non-hypertensive insulin dependent diabetes (IDDM) patients (Abstract). Diabetologia 1996; 39: Suppl. 1: A42.Google Scholar