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| ==Natural History==
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| Not all patients with [[diabetes mellitus]] suffer from diabetic nephropathy. It is estimated that 20-40% of patients with [[diabetes]] develop diabetic nephropathy. The main trigger of diabetic nephropathy is chronic [[hyperglycemia]]. However, a strict glycemic control reduces the rate at which [[microalbuminura]] appears and progress in patients with both type I and type II [[diabetes mellitus]]. However, it is debatable as to whether or not an improved blood [[glucose]] control halts the progression of renal disease once [[microalbuminuria]] is present.
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| The natural history of the disease begins with the development of [[microalbuminuria]], which usually begins 5 years after the onset of [[diabetes]]. The range for [[microalbuminura]] is 30 to 300 mg of [[albumin]] per 24 hours. Over the next 5-10 years, patients are more likely to develop overt [[proteinuria]]. Finally, over the next decade, [[nephrotic syndrome]] is more likely to occur. If left without management, diabetic nephropathy is most likely to be associated with a declining [[GFR]] and ultimately, [[end-stage renal disease]] ([[ESRD]]). At the point of [[ESRD]], [[dialysis]] and [[kidney transplantation]] are the viable options for treatment.
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