Diabetic Nephropathy
Diabetic nephropathy is a disease of the kidneys characterized
by the presence of albumin in the urine, high blood pressure, edema, and
progressive renal insufficiency. This disorder is the most common cause of
renal failure requiring dialysis or transplantation in the United States.
According to the American Diabetes Association nephropathy occurs in 20 to
40 percent of all diabetics.
Despite continuing research, the exact pathologic origin of diabetic
nephropathy is not known. Medical researchers do know, however, that the
thickening of the basement membrane of the glomeruli in the kidneys
eventually impairs renal function. It is suggested that an increased
intracellular concentration of glucose supports the formation of abnormal
glycoproteins in the basement membrane. The accumulation of these large
proteins stimulates glomerulosclerosis which is fibrosis of the glomerular
tissue. Glomerulosclerosis severely impairs the filtering function of the
glomerulus, and protein is lost in the urine.
Kimmelstiel-Wilson Syndrome is a type of glomerulosclerosis found
only in diabetics. In advanced nephropathy, tubular atrophy occurs, and end
stage renal disease results.
The first sign of diabetic nephropathy microalbuminuria, a low but abnormal
level of albumin in the urine. Without medical intervention, diabetics with
type 1 diabetes with constant microalbuminuria will develop overt
nephropathy, accompanied by high blood pressure, over a period of 10 to 15
years.
Type 2 diabetics will often have microalbuminuria and overt nephropathy
shortly after they are diagnosed with diabetes, because the diabetes has
been present but undiagnosed for many years. Because the high blood pressure
accelerates the progress of diabetic nephropathy, aggressive anti high blood
pressure management needs to be instituted.
Management will include control of high blood pressure with medications such
as ACE inhibitors, weight loss, reduced salt intake, and exercise.
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