It has been shown by current data that diabetic nephropathy is the most important single cause of chronic renal failure in adults. In the United States, there are about 50% diabetic nephropathy patients among those that begin hemodialysis.
Type 1 and type 2 diabetes can both cause diabetic nephropathy. Type 1 diabetes has higher incidence to cause renal damages (about 30%-40%) and type 2 has about 20% to develop diabetic nephropathy. However there are some patients having more than 20-25 yeas diabetes without developing diabetic nephropathy, this might be related with their familial or hereditary factors as well as treatments and control for their blood sugar level and blood pressure.
Long term high blood glucose level is the underlying cause of renal damages in diabetic nephropathy. Large amount of blood will flow into the kidneys and be filtered and cleared every minute. Elevated blood sugar can cause increased pressure in the kidneys and damage blood vessels in the kidneys as well as small arteries in other parts of the body such as feet and eyes.
Therefore the first step is to bring high blood sugar down and maintain it in ideal and stable level so as to prevent further renal damages.
The most important clinical sign in the early stage of diabetic nephropathy is slightly higher excretion of albumin in urine. It is called microalbuminuria with 24-h urine albumin 30-300mg.
Once there appears clinical proteinuria (urine protein is more than 0.5g/d), there will be progressive and irreversible decline of glomerular functions. It has been reported that the average illness course of proteinuria is 17 years and the average life expectancy after the onset of proteinuria is about 10 years. There are about 25% will progress into end stage renal failure within 6 years, the percentage is respectively 50% and 75% to develop into renal failure in 10 and 15 years.
High blood pressure can speed up worsening rate of kidney functions and those that have high blood pressure at the same time of high blood glucose will have renal failure within shorter time. Early prevention and proper treatment for high blood pressure can effectively slow down illness progression and prolong patients’ life expectancy.
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