Diabetic Nephropathy

Diabetic Nephropathy

Diabetic nephropathy (DN)—the progressive decline in renal function usually accompanied by proteinuria, hypertension, and declining glomerular filtration rate (GFR)—is a major complication of longstanding diabetes. After 15–25 years of diabetes, approximately 25–40 percent of patients with type 1 diabetes mellitus (T1DM) will ultimately develop signs of renal involvement. According to the USRDS database, diabetic nephropathy is the single most important cause of end stage renal disease (ESRD) in the United States, Japan, and Europe.

New-onset diabetes after transplantation (NODAT) affects up to 50 percent of nondiabetic patients post-kidney transplant depending on the type of study (retrospective versus prospective), the patient population, frequency of sampling, posttransplantation complications, the immunosuppression regimen, duration of follow-up, and diagnostic criteria.

Are common causes of progressive kidney disease regulated by genes?

Many common diseases, including nephropathy, cluster in families, and genetic variants seem likely to regulate disease pathogenesis (1). Until recently, convincing evidence that common disease genes exist has been lacking.

Many therapies exist to treat diabetic kidney disease (DKD). Some have been proven to delay the progression of chronic kidney disease (CKD), while others have not been rigorously tested in a controlled way. This article summarizes the major clinical findings that direct DKD treatment and outlines the progress of ongoing trials whose results will direct care.

By the end of 2007, over 500,000 Americans were afflicted with end stage renal disease (ESRD), and almost 368,000 patients were undergoing dialysis therapy. Diabetes remains the most common cause of ESRD and accounts for over one-half of all new dialysis patients in the United States. Diabetic dialysis patients have poorer outcomes in general compared to nondiabetics. As a result, clinicians and researchers alike are searching for ways to improve outcomes of these patients.