Nephrol Dial Transplant (2001) 16: 11-18
© 2001 European Renal Association-European Dialysis and Transplant Association
Renal disease in type 2 diabetes
1 Ruperto Carola University Heidelberg, Germany and 2 National Yang-Ming University, Taipei Veterans General Hospital, Taiwan
Abstract
The prevalence of type 2 diabetes is rising in all Westernized societies. Presumably as a consequence of diminishing cardiovascular mortality, end-stage renal failure (ESRF) in patients with diabetes (mostly type 2) as a co-morbid condition has risen dramatically in the past decade. This constellation has become the single most common cause of ESRF in most countries. Such an epidemiological trend is particularly regrettable, since in uraemic diabetic patients, medical rehabilitation and survival are remarkably poor. Recent studies indicate that an interplay between genetic predisposition and factors, some of them susceptible to intervention, such as hyperglycaemia, blood pressure, smoking, age, gender and ethnicity, predispose to the development and progression of nephropathy. It has also become clear that trace albuminuria (‘microalbuminuria’) provides unique opportunities to recognize incipient renal involvement early on, although it is less specific in type 2 as compared with type 1 diabetes. Factors that promote progression include hypertension, proteinuria, smoking, glycaemic control and, less certainly, dietary protein intake and hyperlipidaemia. Cumulating evidence indicates that early intervention delays progression of nephropathy. The most important strategies to combat the medical catastrophe of increasing numbers of diabetic patients with ESRF include: (i) prevention of diabetes (mainly type 2); (ii) glycaemic control to prevent onset of renal involvement; and (iii) meticulous antihypertensive treatment to avoid progression of nephropathy.
Keywords: diabetic glomerulopathy; dialysis; end-stage renal failure; hypertension; microalbuminuria; proteinuria
Notes
Correspondence and offprint requests to: Professor Dr E. Ritz, Department Internal Medicine, Bergheimer Straße 58, D-69115 Heidelberg, Germany.
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