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Diabetic Nephropathy

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Principles of Diabetes Mellitus

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Abstract

Diabetes is the most important cause of end stage renal disease (ESRD) in the United States. Over 50% of all new patients entering ESRD programs are now diabetics and over one-third of the entire ESRD population of over 300,000 persons has diabetes mellitus as a cause of renal failure.1 The increase in diabetics as a percentage of all patients developing ESRD has been about 2% annually with no indication of a future decline. The ESRD program cost now exceeds 16 billion dollars annually. The exact percentage of patients with type 1 and type 2 diabetes who will progress to ESRD has been debated. From 25–40% of type 1 patients will develop nephropathy and most will progress to ESRD.2 If a type 1 diabetic has not developed proteinuria at 20–25 years, the risk of renal disease decreases to only a few percent. Of type 2 diabetes patients a smaller percentage will progress to ESRD. Nevertheless, since type 2 diabetics make up a far greater percentage of the overall diabetic population, the total number of diabetics who progress to ESRD is weighted towards type 2 rather than type 1 patients. Moreover, with improved treatment of hypertension and coronary heart disease, more type 2 diabetics are surviving long enough to develop ESRD. White patients have a lower risk of developing ESRD than do Blacks, Hispanics, or native Americans with type 2 diabetes. Almost 50% of diabetic Pima Indians develop nephropathy by 20 years of diabetes and 15% will have progressed by this time to ESRD.

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Authors
  1. Jordan L. Rosenstock
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  2. Gerald B. Appel
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Editors and Affiliations

  1. Division of Endocrinology, Beth Israel Medical Center, New York, New York, USA

    Leonid Poretsky M.D. (Chief, Professor of Medicine) (Chief, Professor of Medicine)

  2. Albert Einstein College of Medicine, New York, New York, USA

    Leonid Poretsky M.D. (Chief, Professor of Medicine) (Chief, Professor of Medicine)

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Rosenstock, J.L., Appel, G.B. (2004). Diabetic Nephropathy. In: Poretsky, L. (eds) Principles of Diabetes Mellitus. Springer, Boston, MA. https://doi.org/10.1007/978-1-4757-6260-0_19

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  • DOI: https://doi.org/10.1007/978-1-4757-6260-0_19

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4757-6262-4

  • Online ISBN: 978-1-4757-6260-0

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