Responding to the challenge of diabetic nephropathy: the historic evolution of detection, prevention and management
| Autor: | George L. Bakris, J. P. Vora, Halijah Ibrahim |
|---|---|
| Rok vydání: | 2000 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Type 2 diabetes Nephropathy Diagnosis Differential Diabetic nephropathy Risk Factors Diabetes mellitus Internal medicine Prevalence Internal Medicine Humans Medicine Diabetic Nephropathies Renal replacement therapy Type 1 diabetes business.industry Incidence medicine.disease Surgery Primary Prevention Survival Rate Transplantation Disease Progression business Kidney disease |
| Zdroj: | Journal of Human Hypertension. 14:667-685 |
| ISSN: | 1476-5527 0950-9240 |
| Popis: | Diabetic nephropathy remains a leading cause of end-stage renal disease (ESRD) in western societies, accounting for about 40% of all patients beginning renal replacement therapy. Patients with type 2 diabetes comprise the largest and fastest growing single disease group requiring renal replacement therapy. In addition to the high risk of progression to ESRD, diabetic nephropathy is associated with a very high risk of cardiovascular (CV) morbidity and mortality, which is not abolished by dialysis or renal transplantation. Over the past two decades there have been major advances in our attempts to understand the risk factors for development and progression of diabetic renal dysfunction, that have resulted in better characterisation of the natural history of this serious complication. Effective antihypertensive treatment and aggressive management of CV risk factors have helped improve the prognosis of patients with overt diabetic nephropathy, particularly those with type 1 diabetes. However, for the larger proportion of patients with type 2 diabetes, the renal and CV prognoses are still poor. Recently, more focus has been placed on treating diabetic patients early in order to prevent future organ damage. Microalbuminuria is an important intermediary end-point that correlates strongly with CV mortality in all people with diabetes as well as progression to ESRD in people with type 1 diabetes. We can now identify patients at high risk early in the natural history of their disease. Clinical trials have uniformly shown that in the early disease history of diabetes, achievement of both tight glucose control, eg, HbA1c |
| Databáze: | OpenAIRE |
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