Diabetic Nephropathy

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Diabetic nephropathy is the most common cause of death and disability in diabetes. Around half of end-stage renal disease is probably due to diabetic nephropathy.

Diabetic nephropathy starts as passage of small quantities of protein in the urine (microalbuminuria). This type of albuminuria is not detected by routine examination of the urine. This first stage of diabetic nephropathy develops around 10-15 years from the onset of high blood sugar. Good control of blood sugar and reduction of blood pressure, if needed, may reverse this first stage of nephropathy.

Microalbuminuria progresses to frank proteinuria within 3-7 years of onset. The decline in kidney function and elevation of blood urea nitrogen (BUN) and creatinine worsen with time. End stage kidney failure usually develops within 5-7 years after the onset of frank proteinuria. Tight control of blood sugar when proteinuria is present does not seem to alter the progression of diabetic nephropathy.

Not all diabetics with poor control of blood sugar develop diabetic nephropathy. Only 50-60% does. The factors that protect the remaining patients are not yet known, but seems to be related to the development of elevated blood pressure. To date, the best way to prevent diabetic nephropathy is to have good control of blood sugar while the nephropathy is still in the microalbuminuric stage.

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