Diabetic nephropathy natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]
Overview
Natural History
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.[1] While a strict glycemic control reduces the rate at which microalbuminura appears and progress in patients with both type I and type II diabetes mellitus, it is debatable as to whether or not an improved blood glucose control halts the progression of renal disease once microalbuminuria is present.[2]
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.[2]
Complications
Possible complications include:
- Hypoglycemia (from decreased excretion of insulin)
- Rapidly progressing chronic kidney failure
- End-stage kidney disease
- Hyperkalemia
- Severe hypertension
- Complications of hemodialysis
- Complications of kidney transplant
- Coexistence of other diabetes complications
- Peritonitis (if peritoneal dialysis used)
- Infections
Prognosis
Diabetic nephropathy continues to get gradually worse. Complications of chronic kidney failure are more likely to occur earlier, and progress more rapidly, when it is caused by diabetes than other causes. Even after initiation of dialysis or after transplantation, people with diabetes tend to do worse than those without diabetes.
References
- ↑ Kasper, Dennis (2015). Harrison's Principles of Internal Medicine. New York, New York: McGraw-Hill. ISBN 0071802150.
- ↑ 2.0 2.1 Nathan DM (1993). "Long-term complications of diabetes mellitus". N. Engl. J. Med. 328 (23): 1676–85. doi:10.1056/NEJM199306103282306. PMID 8487827.