The course of kidney function in Type 2 (non-insulin-dependent) diabetic patients with diabetic nephropathy

Abstract

We evaluated the impact of some putative progression promoters on kidney function in albuminuric Type 2 (non-insulin-dependent) diabetic patients with biopsy-proven diabetic glomerulosclerosis. Twenty-six patients (1 female) with a mean age of 52 (standard error 2) years and a known mean duration of diabetes of 9 (1) years were followed-up prospectively for a mean of 5.2 (range 1.0-7.0) years. Twenty-one patients received antihypertensive treatment. During the observation period the glomerular filtration rate decreased from 83 (24-146) to 58 (2-145) ml.min-1 x 1.73 m-2 (mean (range)) (p < 0.001). The mean rate of decline in glomerular filtration rate was 5.7 (-3.5 to 22.0) ml/min per year. Albuminuria increased from 1.2 (0.3-7.2) to 2.3 (0.4-8.0) g/24 h (geometric mean (range)) (p < 0.001). Arterial blood pressure remained unchanged: 162/93 (SE 4/3) and 161/89 (4/2) mm Hg. Univariate analysis showed the rate of decline in glomerular filtration rate to correlate with systolic blood pressure (r = 0.71, p < 0.001), mean blood pressure (r = 0.56, p < 0.005), albuminuria (r = 0.58, p < 0.005) and the initial glomerular filtration rate (r = -0.49, p < 0.02). The rate of decline in glomerular filtration rate did not correlate significantly with dietary protein intake, total cholesterol, high-density lipoprotein cholesterol or HbA1c. Three patients died from uraemia and four patients died from cardiovascular disease. Two patients required renal replacement therapy at the end of the observation period. Our prospective observational study revealed that one-fifth of the patients developed end-stage renal failure during the 5-year observation period.(ABSTRACT TRUNCATED AT 250 WORDS)

Predictors of the progression of diabetic nephropathy and the beneficial effect of angiotensin-converting enzyme inhibitors in NIDDM patients

“…The cohort appeared to have a Hazard ratio (95 % CI) indicates alteration of risk per unit increase of baseline variables sufficient number of subjects who developed ESRF and of control subjects in order to evaluate the progression of nephropathy. Our study showed that the rate of decline of renal function is highly variable, as seen in other studies [15,18,19]. In addition to the effects of putative progression promoters such as proteinuria, systemic blood pressure, and hypercholesterolaemia, the results of the present study demonstrated the effects of hypoalbuminaemia, smoking, and familial predisposition to hypertension on the development of ESRF which were independent of the effect of urinary protein excretion.…”

Glomerular size-and charge selectivity in Type 2 (non-insulin-dependent) diabetic patients with diabetic nephropathy

“…We also found a positive correlation between the systolic blood pressure and the clearance of all three proteins in these patients. We have recently demonstrated a significant correlation between systolic blood pressure and the ensuing rate of decline in glomerular filtration rate in Type 2 diabetic patients with diabetic nephropathy [31]. Since impaired autoregulation of glomerular filtration rate is frequently present in diabetic nephropathy, systemic hypertension will induce hyperperfusion and glomerular hypertension [32].…”

Are glomerular volume differences between type 1 and type 2 diabetic patients pathologically significant?

“…Nephropathy in both type 1 and type 2 diabetes is characterised by proteinuria, declining GFR and increasing blood pressure [1,2]. The development of glomerular and interstitial lesions is also common to the two types of diabetes [3][4][5][6].…”

“…The development of glomerular and interstitial lesions is also common to the two types of diabetes [3][4][5][6]. However, the reported rate of progress varies, particularly in type 2 diabetic patients, where the decline in GFR can range from +3.1 to −22.0 ml min −1 year −1 [2,[7][8][9]. In type 1 diabetic patients, the average rate of decline is 10 ml min −1 year −1 in those with poorly controlled blood pressure and 4.8 ml min −1 year −1 in those with good blood pressure control [10].…”