Risk factors in diabetic nephropathy

Excerpt

Diabetes morbidity and mortality is mainly determined by the late chronic complications of diabetes. Though the macrovascular complications affecting the heart is the leading cause of mortality in diabetes, nephropathy is slowly becoming an important factor in determining the final outcome. This is because of better prevention and treatment of cardiovascular problems with the availability of newer drugs and devices, thereby making diabetic patients live longer. Also it is a well accepted fact, that patients of diabetic nephropathy are more predisposed to cardiovascular and peripheral vascular diseases. Even though the hyperglycemia is closely related to the development of microvascular complications, the evidence of direct relationship between hyperglycemia and nephropathy is less convincing in humans, as only 30% of diabetic patients develop clinical nephropathy [1]. Majority of patients escape renal failure even though some histological evidence of renal damage is present in many. It is unclear why some diabetic patients are more susceptible than others for the development of renal disease. Inherited factors may be providing protection from susceptibility to diabetic nephropathy, but evidence is lacking as to which factors are important. Familial predisposition to raised arterial pressure increases the susceptibility to renal disease in patients with diabetes. Studies have demonstrated that mean blood pressure levels are significantly higher in those who progress to microalbuminuria, than in those who do not, indicating that hypertension is an important risk factor for diabetic nephropathy [2]. There is evidence of familial clustering of diabetic nephropathy in type 2 diabetes and the affected sib-pair linkage analysis have identified loci associated with diabetic nephropathy in type 2 diabetes [3, 4]. Interstingly, in Pima Indians blood pressure levels before the onset of diabetes, predicts the future risk of developing nephropathy [5] …