Diseases of Renal Microcirculation: Diabetic Nephropathy

  • Ineke J. Riphagen
  • Hiddo J. Lambers Heerspink
  • Rijk O. B. Gans
  • Carlo A. J. M. Gaillard
Reference work entry
First Online:

Abstract

The prevalence of diabetes mellitus and its long-term vascular complications are increasing worldwide. Diabetic nephropathy is one of the main microvascular complications of diabetes and is characterized by the development of persistent macroalbuminuria (i.e., a urinary albumin excretion [UAE] >300 mg/24 h) or proteinuria (i.e., a urinary protein excretion >0.5 g/24 h).

Characteristic glomerular changes of diabetic nephropathy include thickening of the glomerular basement membrane (GBM), mesangial expansion, and podocyte injury. Since type 1 and type 2 diabetic nephropathies share similar histologic characteristics as well as structural-functional relationships, one common classification is used to describe the pathologic classification of diabetic nephropathy for both type 1 and 2 diabetes.

Although UAE should rather be considered as a continuous variable rather than using specific cutoff values, we describe the clinical course of diabetic nephropathy based on the classic approach using three stages based on urinary albumin excretion (i.e., normoalbuminuria, microalbuminuria, and macroalbuminuria).

Diabetic nephropathy is a major independent risk factor for diabetes-related morbidity and mortality. However, a number of interventions are available that can reduce the risk of developing diabetic nephropathy and slow the progression hereof. Key treatment strategies that could reduce the incidence and progression of diabetic nephropathy include blood glucose control, blood pressure control, lipid-lowering therapy, and lifestyle interventions.

Keywords

Bariatric Surgery Glomerular Filtration Rate Diabetic Nephropathy American Diabetes Association Angiotensin Receptor Blocker 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Glossary of Terms

Albuminuria

Condition wherein too much albumin is present in urine.

Atherosclerosis

A common form of arteriosclerosis in which fatty substances form a deposit of plaque on the inner lining of arterial walls.

Diabetes mellitus

A metabolic disorder that is clinically characterized by hyperglycemia.

Diabetic nephropathy

Diabetic kidney disease characterized by the presence of albuminuria or proteinuria.

Dyslipidemia

A disorder of lipid metabolism, including overproduction or deficiency.

End-stage renal disease

Late stage of kidney disease in which renal replacement therapy is needed.

Glomerular hyperfiltration

An elevation in the glomerular filtration rate that can occur in various clinical conditions including diabetes mellitus.

Hypertension

High blood pressure; systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg.

Macroalbuminuria

Presence of large amounts of albumin in urine; urinary albumin excretion of >300 mg/day.

Microalbuminuria

Presence of small amounts of albumin in urine; urinary albumin excretion of 30–300 mg/day.

Normoalbuminuria

Presence of normal amounts of albumin in urine; urinary albumin excretion of <30 mg/day.

Proteinuria

Condition wherein too much protein is present in urine.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Ineke J. Riphagen
    • 1
  • Hiddo J. Lambers Heerspink
    • 2
  • Rijk O. B. Gans
    • 3
  • Carlo A. J. M. Gaillard
    • 1
  1. 1.Department of Internal Medicine, Division of NephrologyUniversity Medical Center Groningen (UMCG), University of GroningenGroningenThe Netherlands
  2. 2.Department of Clinical PharmacologyUniversity Medical Center Groningen (UMCG), University of GroningenGroningenThe Netherlands
  3. 3.Department of Internal MedicineUniversity Medical Center Groningen (UMCG), University of GroningenGroningenThe Netherlands

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