0
April 11, 1990, Vol 263, No. 14 >
ARTICLE | April 11, 1990

The Natural History and Epidemiology of Diabetic Nephropathy: Title and subTitle BreakImplications for Prevention and Control FREE

Joseph V. Selby, MD; Stacey C. Fitz-Simmons, PhD; Jeffrey M. Newman, MD; Patricia P. Katz, PhD; Stephen Sepe, MPH; Jonathan Showstack, MPH
[+] Author Affiliations

Reprint requests to Division of Research, Kaiser Permanente Medical Care Program, 3451 Piedmont Ave, Oakland, CA 94611-5463 (Dr Selby).


JAMA. 1990;263(14):1954-1960. doi:10.1001/jama.1990.03440140080036
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References

PERSONS with diabetes are at increased risk for several types of kidney disease,1 but the predominant cause of end-stage renal disease (ESRD) in this disorder is diabetic nephropathy—a complication unique to diabetes. Since the initiation of Medicare coverage for treatment of ESRD in 1972, the proportion of new ESRD cases attributed to diabetic nephropathy has increased from approximately 10% in 19732 to 30% in 1987.3 Diabetes is now the single most frequent reason for beginning treatment of ESRD, with 10 025 new cases caused by diabetic nephropathy in 1987.3

In this article, we review the natural history and epidemiology of diabetic nephropathy and the evidence for efficacy of preventive and therapeutic measures. From this review, a strategy for preventing and controlling this important cause of morbidity is outlined.

NATURAL HISTORY OF DIABETIC KIDNEY DISEASE  Diabetic nephropathy is currently defined by the presence of a persistently positive

REFERENCES

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2 +
Sugimoto T, Rosansky SJ.  The incidence of treated end-stage renal disease in the eastern United States: 1973-1979 . Am J Public Health. 1984;; 74:14-17.
3 +
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4 +
Mogensen CE, Christensen CK, Vittinghus E.  The stages in diabetic nephropathy: with emphasis on the stage of incipient diabetic nephropathy . Diabetes. 1983;;32( (suppl 2) ):64-78.
5 +
Mogensen CE.  Renal function changes in diabetes . Diabetes. 1976;;25( (suppl 2) ):872-879.
6 +
Osterby R, Gundersen HJG.  Glomerular size and structure in diabetes mellitus, I: early abnormalities . Diabetologia. 1975;;11:225-229.
7 +
Hirose K, Tsuchida H, Osterby R, Gundersen JHG.  A strong correlation between glomerular filtration rate and filtration surface in diabetic kidney hyperfunction . Lab Invest. 1980;;43:434-437.
8 +
Hostetter TH, Rennke HG, Brenner BM.  The case for intrarenal hypertension in the initiation and progression of diabetic and other glomerulopathies . Am J Med. 1982;;72:375-380.
9 +
Anderson S, Brenner BM.  Influence of antihypertensive therapy on development and progression of diabetic glomerulopathy . Diabetes Care. 1988;;11:846-849.
10 +
Parving H-H, Noer I, Deckert T, et al.  The effect of metabolic regulation on microvascular permeability to small and large molecules in short-term juvenile diabetics . Diabetologia. 1976;;12:161-166.
11 +
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Chavers BM, Bilous RW, Ellis EN, Steffes MW, Mauer SM.  Glomerular lesions and urinary albumin excretion in type I diabetes without overt proteinuria . N Engl J Med. 1989;;320:966-970.
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Hasslacher C, Stech W, Wahl P, Ritz E.  Blood pressure and metabolic control as risk factors for nephropathy in type I (insulin-dependent) diabetes . Diabetologia. 1985;;28:6-11.
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Borch-Johnsen K, Andersen PK, Deckert T.  The effect of proteinuria on relative mortality in type I (insulin-dependent) diabetes mellitus . Diabetologia. 1985;;28:590-596.
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Cowie CC, Port FK, Wolfe RA, Savage PJ, Moll PP, Hawthorne VM.  Disparities in incidence of diabetic end-stage renal disease according to race and type of diabetes . N Engl J Med. 1989;;321:1074-1079.
93 +
Nelson RG, Pettitt DJ, Carraher MJ, Baird HR, Knowler WC.  Effect of proteinuria on mortality in NIDDM . Diabetes. 1988;;37:1499-1504.
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Nelson RG, Newman JM, Knowler WC, et al.  Incidence of end-stage renal disease in type 2 diabetes mellitus in Pima Indians . Diabetologia. 1988;; 31:730-736.
95 +
Pugh JA, Stern MP, Zapata M.  Excess incidence of treatment of end-stage renal disease in Mexican-Americans . Am J Epidemiol . 1988;;127: 135-144.
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Newman JM, Marfin AA, Eggers PW, Helgerson SD.  End-stage renal disease among Native Americans . Am J Public Health. 1990;;80:318-319.
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Haffner SM, Mitchell BD, Pugh JA, et al.  Proteinuria in Mexican-Americans and non-Hispanic whites with NIDDM . Diabetes Care. 1989;;12:530-536.
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Eggers PW, Connerton R, McMullan M.  The Medicare experience with end-stage renal disease . Health Care Financ Rev. 1984;;5:69-88.
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Raskin P, Rosenstock J.  Aldose-reductase inhibitors and diabetic complications . Am J Med. 1987;;83:298-306.
100 +
Nath KA.  Platelets, antiplatelet therapy, and diabetic nephropathy . Mayo Clin Proc. 1988;;63:80-85.
101 +
Watts GF, Hodgson B, Morris RW, Shaw KM, Polak A.  Side-room tests to screen for microalbuminuria in diabetes mellitus . Diabetes Med. 1988;;5:298-303.
102 +
Linton AS, Rowe DJF.  Ames' 'Microbumintest' evaluated, and its correlation with total protein and albumin concentration in urine . Clin Chem. 1988;;34:1927-1928.
103 +
Coonrod BA, Ellis D, Becker DJ, et al.  Assessment of Albusure and its usefulness in identifying IDDM subjects at increased risk for developing clinical diabetic nephropathy . Diabetes Care. 1989;; 12:389-393.
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Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Friedman EA.  Diabetic renal disease . In: Ellenberg M, Rifkin H, eds. Diabetes Mellitus: Theory and Practice . New York, NY: Medical Examination Publishing Co Inc; 1983;:759-776.
2 +
Sugimoto T, Rosansky SJ.  The incidence of treated end-stage renal disease in the eastern United States: 1973-1979 . Am J Public Health. 1984;; 74:14-17.
3 +
US Renal Data System. 1989 Annual Data Report . Bethesda, Md: National Institute of Diabetes and Digestive and Kidney Diseases; 1989;.
4 +
Mogensen CE, Christensen CK, Vittinghus E.  The stages in diabetic nephropathy: with emphasis on the stage of incipient diabetic nephropathy . Diabetes. 1983;;32( (suppl 2) ):64-78.
5 +
Mogensen CE.  Renal function changes in diabetes . Diabetes. 1976;;25( (suppl 2) ):872-879.
6 +
Osterby R, Gundersen HJG.  Glomerular size and structure in diabetes mellitus, I: early abnormalities . Diabetologia. 1975;;11:225-229.
7 +
Hirose K, Tsuchida H, Osterby R, Gundersen JHG.  A strong correlation between glomerular filtration rate and filtration surface in diabetic kidney hyperfunction . Lab Invest. 1980;;43:434-437.
8 +
Hostetter TH, Rennke HG, Brenner BM.  The case for intrarenal hypertension in the initiation and progression of diabetic and other glomerulopathies . Am J Med. 1982;;72:375-380.
9 +
Anderson S, Brenner BM.  Influence of antihypertensive therapy on development and progression of diabetic glomerulopathy . Diabetes Care. 1988;;11:846-849.
10 +
Parving H-H, Noer I, Deckert T, et al.  The effect of metabolic regulation on microvascular permeability to small and large molecules in short-term juvenile diabetics . Diabetologia. 1976;;12:161-166.
11 +
Osterby R.  Early phases in the development of diabetic glomerulopathy: a quantitative electron microscopic study . Acta Med Scand Suppl. 1974;; ( (574) ):1-82.
12 +
Steffes MW, Ellis EN, Mauer SM.  Complications of diabetes mellitus and factors affecting their progression . Clin Chem. 1986;;32( (suppl B) ):B54-B61.
13 +
Mauer SM, Steffes MW, Goetz FC, Sutherland DER, Brown DM.  Diabetic nephropathy: a perspective . Diabetes. 1983;;32( (suppl 2) ):52-55.
14 +
Steffes MW, Osterby R, Chavers B, Mauer SM.  Mesangial expansion as a central mechanism for loss of kidney function in diabetic patients . Diabetes. 1989;;38:1077-1081.
15 +
Ellis D, Becker DJ, Dameron D, Lobes L, Drash AL.  Proteinuria in children with insulindependent diabetes: relationship to duration of disease, metabolic control, and retinal changes . J Pediatr. 1983;;102:673-680.
16 +
Mathiesen ER, Saurbrey N, Hommel E, Parving H-H.  Prevalence of microalbuminuria in children with insulin-dependent diabetes . Acta Endocrinol Suppl (Copenh) . 1986;;275:14.
17 +
Niazy S, Feldt-Rasmussen B, Deckert T.  Microalbuminuria in insulin-dependent diabetes: prevalence and practical consequences . J Diabetic Complications. 1987;;1:76-80.
18 +
Damsgaard EM, Mogensen CE.  Microalbuminuria in elderly hyperglycemic patients and controls . Diabetic Med. 1986;;3:430-435.
19 +
Uusitupa M, Siitonen O, Penttila I, Antti A, Pyorala K.  Proteinuria in newly diagnosed type II diabetic patients . Diabetes Care. 1987;;10:191-194.
20 +
Parving H-H, Oxenboll B, Svendsen PA, Christensen JS, Andersen AR.  Early detection of patients at risk of developing diabetic nephropathy: a longitudinal study of urinary albumin excretion . Acta Endocrinol (Copenh) . 1982;;100:550-555.
21 +
Viberti GC, Hill RD, Jarrett RJ, Argyropoulous A, Mahmud U, Keen H.  Microalbuminuria as a predictor of clinical nephropathy in insulin-dependent diabetes mellitus . Lancet. 1982;;1:1430-1432.
22 +
Mathiesen ER, Oxenboll B, Johansen K, Svendsen PAA, Deckert T.  Incipient nephropathy in type I (insulin-dependent) diabetes . Diabetologia. 1984;;26:406-410.
23 +
Mogensen CE, Christensen CK.  Predicting diabetic nephropathy in insulin-dependent patients . N Engl J Med. 1984;;311:89-93.
24 +
Bennett PH.  'Microalbuminuria' and diabetes: a critique—assessment of urinary albumin excretion and its role in screening for diabetic nephropathy . Am J Kidney Dis. 1989;;13:29-34.
25 +
Chavers BM, Bilous RW, Ellis EN, Steffes MW, Mauer SM.  Glomerular lesions and urinary albumin excretion in type I diabetes without overt proteinuria . N Engl J Med. 1989;;320:966-970.
26 +
Mogensen CE.  Microalbuminuria predicts clinical proteinuria and early mortality in maturityonset diabetes . N Engl J Med. 1984;;310:356-360.
27 +
Jarrett RJ, Viberti BC, Argyropoulous A, Hill RD, Mahmud U, Murrells TJ.  Microalbuminuria predicts mortality in non-insulin-dependent diabetes . Diabetic Med. 1984;;1:17-19.
28 +
Andersen AR, Christiansen JK, Andersen JK, Kreiner S, Deckert T.  Diabetic nephropathy in type I (insulin-dependent) diabetes: an epidemiological study . Diabetologia. 1983;;25:496-501.
29 +
Krolewski AS, Warram JH, Christlieb AR, Busick EJ, Kahn CR.  The changing natural history of nephropathy in type I diabetes . Am J Med. 1985;;78:785-794.
30 +
Parving H-H, Andersen AR, Smidt UM, Christensen JS, Oxenboll B, Svendsen PAA.  Diabetic nephropathy and arterial hypertension: the effect of antihypertensive treatment . Diabetes. 1983;;32( (suppl 2) ):83-87.
31 +
Deckert T, Poulsen JE, Larsen M.  Prognosis of diabetics with diabetes onset before the age of thirty-one, II: factors influencing the prognosis . Diabetologia . 1978;;14:371-377.
32 +
Hasslacher C, Stech W, Wahl P, Ritz E.  Blood pressure and metabolic control as risk factors for nephropathy in type I (insulin-dependent) diabetes . Diabetologia. 1985;;28:6-11.
33 +
Borch-Johnsen K, Andersen PK, Deckert T.  The effect of proteinuria on relative mortality in type I (insulin-dependent) diabetes mellitus . Diabetologia. 1985;;28:590-596.
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