The Incidence And Severity Of Diabetic Nephropathy

Genetic susceptibility — Genetic susceptibility may be an important determinant of both the incidence and severity of diabetic nephropathy. The likelihood of developing diabetic nephropathy is markedly increased in patients with a diabetic sibling or parent who has diabetic nephropathy. Age — For type 1 diabetes, the risk of developing ESRD is very low for patients diagnosed prior to age 5; at older ages, the relationship of age to progression to ESRD is uncertain Blood pressure — Higher blood pressures have been noted to be associated with diabetic nephropathy. Obesity — A high body mass index (BMI) in patients with diabetes has been associated with an increased risk of chronic kidney disease. In addition, diet and weight loss may†¦show more content†¦Metabolic memory applies in nephropathy. In nephropathy, significant persistent benefits were noted in those who had received intensive therapy compared with those who received conventional therapy during the DCCT. After eight years of follow-up in EDIC, patients originally assigned to intensive glycemic control were significantly less likely to develop new microalbuminuria (7 versus 16 percent), new clinical albuminuria, also called macroalbuminuria, (1.4 versus 9 percent), and hypertension (30 versus 40 percent). After 16 years of follow-up in EDIC (22 years since in the start of the DCCT trial), patients originally assigned to intensive glycemic control were significantly less likely to develop impaired renal function, defined as an estimated glomerular filtration rate less than 60 mL/min per 1.73 m2 (3.9 versus 7.6 percent). Hyperlipidemia is common in diabetic patients, a tendency that is increased by the development of renal insufficiency. Aggressive lipid lowering is an important part of the medical management of all diabetic patients since diabetes is considered a coronary heart disease equivalent. An elevation in lipid levels also may contribute to the development of glomerulosclerosis in chronic kidney disease. A prospective study in patients with type 1 diabetes mellitus found that a plasma cholesterol concentration above 220 mg/dL (5.7 mmol/L) was an important risk factor for progressive renal disease,