Comparative renal pathophysiology relevant to IDDM and NIDDM patients

Abstract

I. PATHOPHYSIOLOGICAL CHANGES IN THE DIABETIC KIDNEYThe main pathophysiological changes found early in the course of renal involvement in IDDM patients are glomerular hyperfiltration and microalbuminuria. ' These abnormalities may be early reversible indicators of the metabolic aberration, whereas persistent, increased microalbuminuria is a clear sign of incipient renal damage. These changes are, however, not specific for diabetes. Hyperfiltration may be found in acromegaly, in pregnancy, or after uni-nephrectomy. Microalbuminuria may be found in hypertension and possibly in renal disorders with only slight involvement, but this issue is less clarified.This article reviews results within this field, with emphasis of comparison of data in insulindependent (IDDM) and non-insulin-dependent diabetes (NIDDM). Renal involvement in two other well-characterized entities, essential hypertension and the one-kidney-situation, will also be discussed, for comparative reasons and with the purpose of a better understanding of renal pathophysiology in diabetes. In the NIDDM patients, studies are few, but there is increasing interest in this area now. Also, most review articles deal with IDDM14 rather than NIDDM.5 Detailed knowledge of the natural history and pathophysiology of renal involvement and nephropathy in diabetes form the main basis for developing new ways of intervention, glycemic as well as nonglycemic, and such treatment modalities will also briefly be discussed, with the basis in the described abnormalities in renal function.

Incidence and Determinants of Microalbuminuria in Koreans With Type 2 Diabetes

“…Studies in Caucasian populations showed that end-stage renal disease (ESRD) occurs in 30-40% of patients with type 1 diabetes, but less frequently in patients with type 2 diabetes (11,12). Studies in black Americans and Pima Indians showed that the incidence of ESRD due to type 2 diabetes is about four to six times higher in these populations than in Caucasians (12)(13)(14).…”

“…Normoalbuminuria was considered to be present if UAE was consistently < 2 0 ug/min. Microalbuminuria was defined as a mean of UAE between 20 and 200 ug/min and overt proteinuria as a mean UAE >200 ug/min (11). Among the 248 patients, 32 had microalbuminuria and 28 had overt proteinuria at baseline.…”

Epidemiology, development and treatment of end-stage renal failure in Type 2 (non-insulin-dependent) diabetes mellitus

“…It has been shown by Palmisano et al [26] that glomerular hyperfiltration occurs in 40 % of Black Ameri-cans with Type 2 diabetes followed-up for as long as 8 years and with well-controlled glycaemia for several months. This is in contrast with White Type 2 diabetic patients [27]. In French OT, nutritional habits are different in Caucasian and non-Caucasian communities.…”

Microalbuminuria and Potential Confounders: A review and some observations on variability of urinary albumin excretion

“…Usually, very high values of BP (50 mmHg more than in IDDM patients with microalbuminuria) are needed to provoke increases in UAER in essential hypertension (48,49). In diabetes, the relationship between increased BP and hypertension is intriguing.…”