Prevalence and Management of Diabetic Nephropathy in Western Countries

Background: Diabetic nephropathy (DN) often results in end-stage renal disease, and this is the most common reason for initiation of dialysis in the United States. Complications of diabetes, particularly renal disease, substantially increase the risk of subsequent severe illness and death. The prevalence of DN is still rising dramatically, with concomitant increases in associated mortality and cardiovascular complications. Summary: Renal involvement in type 1 and type 2 diabetes reflects a complex pathogenesis. Various genetic and environmental factors determine the susceptibility and progression to advanced stages of the disease. DN should be considered in patients who have had type 1 diabetes for at least 10 years with microalbuminuria and diabetic retinopathy, as well as in patients with type 1 or type 2 diabetes with macroalbuminuria in whom other causes for proteinuria are absent. The glomerular characteristic features include mesangial expansion, thickened glomerular basement membrane, and hyalinosis of arterioles. The optimal therapy of DN continues to evolve. For all diabetic patients, practical management including blood glucose and blood pressure control with renin-angiotensin-aldosterone blockade combined with lipid control, dietary salt restriction, lowering the Received: March 31, 2015 Accepted after revision: April 2, 2015 Published online: May 1, 2015 Dr. Sharon G. Adler Nephrology and Hypertension Division Los Angeles Biomedical Research Center 1124 Carson Street, Torrance, CA 90502 (USA) E-Mail sadler @ labiomed.org © 2015 S. Karger AG, Basel 2296–9381/15/0011–0061$39.50/0 www.karger.com/kdd For the prevalence and management of diabetic nephropathy in Asia, see Tomino and Gohda, Kidney Dis 2015, DOI: 10.1159/000381757, www.karger.com/doi/0003881757. D ow nl oa de d by : 54 .7 0. 40 .1 1 10 /3 /2 01 7 5: 48 :1 9 A M