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Recent advances in diabetic nephropathy

Lookup NU author(s): Emerita Professor Sally Marshall


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Diabetic nephropathy is the most common cause world-wide of renal failure requiring renal replacement therapy, most patients having type 2 rather than type 1 diabetes. Cardiovascular risk increases progressively as nephropathy develops. In addition to abnormalities in the glomerular endothelium and mesangium, recent data suggest that changes are also seen in the glomerular epithelial cell or podocyte. The foot processes of the podocyte broaden and efface and there is loss of podocyte specific proteins such as nephrin. Eventually there is loss of podocytes themselves. These changes may contribute to proteinuria. The development of nephropathy can be prevented by good glucose and blood pressure control. Once microalbuminuria or proteinuria are present, control of intraglomerular pressure, using inhibitors of the renin-angiotensin system, and control of systemic blood pressure are paramount, and can delay the need for renal replacement therapy by many years. Aggressive management of cardiovascular risk factors also slows the progression of nephropathy and prevents cardiovascular events.

Publication metadata

Author(s): Marshall SM

Publication type: Article

Publication status: Published

Journal: Clinical Medicine, Journal of the Royal College of Physicians of London

Year: 2004

Volume: 4

Issue: 3

Pages: 277-282

ISSN (print): 1470-2118

ISSN (electronic): 1473-4893

Publisher: Royal College of Physicians

PubMed id: 15244365