Risk Factors Associated with Diabetic Nephropathy and Their Clinical Significance

Abstract

The purpose of the study was to highlight the most studied risk factors associated with the development and/or progression of diabetic nephropathy, with an emphasis on some important aspects that should be kept in mind by the physician. Materials and methods. Research materials are publications of national and foreign authors. The methods used were: system approach and system theoretical retrospective analysis of selected materials; generalization; medical and statistical method. Results and discussion. Timely diagnostics of diabetic nephropathy and elimination of risk factors of its development and progression are emphasized to be a difficult task of clinics of internal diseases particularly in conditions when amount of these risk factors is constantly growing. The most investigated risk factors associated with development and progression of diabetic nephropathy such as age, arterial hypertension, disorders of carbohydrate and lipid exchange, proteinuria are discussed in the article. Some peculiarities of correction of metabolic risk factors such as hyperglycemia and dyslipidemia as well as hemodynamic risk factors such as arterial hypertension and intraglomerular hypertension participated in development and progression of diabetic nephropathy are discussed with consideration of acting recommendations. Some aged and gender peculiarities of change of glomerular filtration rate as well as a role of arterial hypertension in progression of diabetic nephropathy through albuminuria are considered. A significance of glycosylated hemoglobin level as an independent risk factors of microalbuminuria is demonstrated. A role of secondary lipid exchange disorders due to type 2 diabetes mellitus in reduction of glomerular filtration rate and elevation of albumin/creatinine ratio as well as albuminuria presence is emphasized. A necessity of urinal detection of nephrin and podocin levels for an early diagnostics of diabetic nephropathy and monitoring of renal glomerular dysfunction in diabetes mellitus is discussed. Some risk factors related to appearance of albuminuria as well as association of albuminuria and proteinuria with glomerular and tubular structural changes in kidney are considered. A clinical significance of albumin/creatinine ratio calculation as an alternative to daily urinal protein concentration measuring for diabetic nephropathy screening is emphasized. Some risk factors related to close positive correlation with this ratio are considered. A role of genetic factors in the development of diabetic nephropathy with a participation of known today some genes candidates and a necessity of genealogical anamnesis definition to reveal a patient’s susceptibility to development of diabetic nephropathy is discussed. Conclusion. The contemporary recommendations for control of glycemia, correction of dyslipidemia and arterial hypertension which allow significantly reduce a risk of kidney impairment in diabetes mellitus or inhibit a progression of diabetic nephropathy in patients with albuminuria and proteinuria are given. A significance of detailed investigation of principles of development and progression of diabetic nephropathy for collaboration of effective diagnostic, treatment and preventive measures is emphasized