Diabetic nephropathy

Diabetic nephropathy is a major underlying cause of morbidity and mortality in both type 1 and type 2 diabetes mellitus, giving rise principally to cardiovascular disease, in particular heart failure, the incidence of which is about 15-fold greater in patients with diabetic kidney disease. The all-cause mortality in patients with diabetic nephropathy is nearly 20–40 times higher than in patients without nephropathy. Many patients with diabetes, in particular type 2 diabetes, and renal impairment die from cardiovascular disease well before they progress to end-stage renal disease. Nevertheless, diabetic nephropathy is the most common cause of end-stage renal disease worldwide. Suboptimal glycaemic control and a higher blood pressure are particularly important risk factors for the development of diabetic nephropathy. Over a lifetime, diabetic nephropathy occurs in approximately 30–35% of patients with type 1 and type 2 diabetes. The disease can be detected in most cases many years before the development of advanced renal failure through the detection of raised urinary albumin excretion – microalbuminuria. Early detection allows time for the intensive treatment of glycaemic control, blood pressure and other cardiovascular risk factors, such as lipids, in order to reduce the morbidity and mortality.