The Clinical Course of Diabetic Nephropathy

Kussman, Michael J.

doi:10.1001/jama.1976.03270170027020

Cited by 148 publications

(49 citation statements)

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“…A median survival of 5±7 years after onset of proteinuria has been reported [21]. Our study in which aggressive antihypertensive treatment was applied revealed minimal changes in arterial blood pressure, a small rise in albuminuria, a major reduction in the rate of decline in glomerular filtration rate (3.2 ml/min/year) and improved survival (median > 18 years).…”

Section: Discussionsupporting

confidence: 55%

Pregnancy and progression of diabetic nephropathy

et al. 2002

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Section: Discussionsupporting

confidence: 55%

Pregnancy and progression of diabetic nephropathy

et al. 2002

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Section: The Changing Course Of Diabetic Kidney Diseasementioning

confidence: 99%

“…Overt diabetic nephropathy with persistent proteinuria has traditionally had a poor prognosis, characterised by a relentless decline in renal function, development of end-stage renal failure and a median survival time of only 6-7 years after onset of nephropathy [9,10]. As Kussman et al remarked in 1976, "once the clinical signs of nephropathy have become manifest, the natural course is inexorably progressive to death" [9]. There was, therefore, considerable interest in a study from Sweden that, in 1994, reported a dramatic decline in the incidence of diabetic nephropathy: the 20-year cumulative incidence fell from 28% in patients with onset of type 1 diabetes from 1961-1965 to only 5.8% in patients with onset of diabetes from 1971-1975 [11].…”

Section: The Changing Course Of Diabetic Kidney Diseasementioning

confidence: 99%

“…In their paper, Kussman et al state that diabetic nephropathy is irreversible [9]; however, the observation that morphological lesions of diabetic nephropathy can be reversed by normoglycaemia following pancreas transplantation implies that microvascular lesions in the kidney are potentially reversible [29]. Regression of the earlier stages of microalbuminuria has been demonstrated following antihypertensive treatment, and one prospective observational study reported that, over a 7.5-year follow-up period, regression occurred in 35% of 79 type 1 patients with microalbuminuria (in 39% of patients treated with an ACE inhibitor and in 13% of untreated patients).…”

Section: The Changing Course Of Diabetic Kidney Diseasementioning

confidence: 99%

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The changing epidemiology of diabetic microangiopathy in type 1 diabetes

Rossing

2005

Diabetologia

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Diabetic microvascular complications in the kidney and the eye are a major burden for diabetic patients due to increased morbidity and mortality. Furthermore, diabetic nephropathy is the leading cause of end-stage renal disease and diabetic retinopathy is the leading cause of blindness in younger patients, representing a major public health concern. During the past two decades beneficial effects of, in particular, aggressive antihypertensive control and strict glycaemic control have been demonstrated in randomised controlled clinical trials. Technological improvements in diabetes care have made good metabolic control easier to achieve. Has this led to an improved prognosis? In observational studies from dedicated centres, a decrease from 47 to 13% has been reported in the incidence of proliferative diabetic retinopathy after 20-25 years of diabetes, and the incidence of overt diabetic nephropathy after 20 years has decreased from 28 to 5.8%. Even functional and morphological remission of diabetic nephropathy has been reported. Despite this, recent population-based studies have failed to demonstrate a decrease in the incidence of blindness caused by diabetes, and the incidence of end-stage renal disease has progressively increased. This may, in part, be the result of a combination of increasing numbers of diabetic patients and a lag phase between improvement in management and a decline in end-stage complications. It is of concern, however, that the results from specialised centres may not apply to routine diabetes care. It is, therefore, mandatory that the beneficial effects of pharmacological and non-pharmacological interventions demonstrated in clinical trials and recommended by treatment guidelines are translated into clinical practice to ensure a widespread improvement in prognosis.

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“…The causes of death in IDDM patients with nephropathy have been strikingly similar in the United Kingdom (24), Denmark (25), and Boston, Massachusetts (26) (Fig. 3).…”

Section: Prognosis and Therapymentioning

confidence: 87%

Clinical Features and Health-Care Costs of Diabetic Nephropathy

Narins

1988

Diabetes Care

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The nephropathy complicating insulin-dependent diabetes mellitus (IDDM) has been well studied, but that complicating non-insulin-dependent diabetes mellitus (NIDDM) is less well defined. In patients with IDDM, the glomerular filtration rate is often increased early in the course of the disease, approaches normal with insulin therapy, but tends to remain slightly elevated throughout the ensuing 10-15 yr of insulin dependency. After the onset of overt azotemia, end-stage renal disease (ESRD) develops in ~5 yrs. Proteinuria may be intermittently positive in the earliest stages of diabetes, evolving into intermittent and then persistent /n/croalbuminuria, which in turn blossoms into /nacroalbuminuria. Because 40-50% of IDDM patients develop proteinuria and two-thirds of this subpopulation develop ESRD, some 20-30% of any given cohort of IDDM patients eventually need dialysis or transplantation. Evidence indicates that diabetic nephropathy is associated with a greater incidence of eye, nerve, heart, and peripheral vascular disease. Nondiabetic renal disease complicating IDDM and NIDDM is associated with a lesser frequency and severity of these extrarenal manifestations, the prevalence of retinopathy increases with advancing nephropathy. Roughly two-thirds of the deaths from IDDM are related to renal failure, and most of the remainder are caused by associated cardiovascular disease. Transplantation from living relatives carries the best prognosis for survival, and little difference is seen between hemodialysis, peritoneal dialysis, and cadaver transplantation. The health-care costs of treating diabetic nephropathy are also reviewed. Diabetes Care

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The Clinical Course of Diabetic Nephropathy

Cited by 148 publications

References 4 publications

Pregnancy and progression of diabetic nephropathy

Pregnancy and progression of diabetic nephropathy

The changing epidemiology of diabetic microangiopathy in type 1 diabetes

Clinical Features and Health-Care Costs of Diabetic Nephropathy

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