Diabetic nephropathy

Definition

Diabetic nephropathy is kidney disease or damage that results as a complication of diabetes.

See also:

• Type 1 diabetes
• Type 2 diabetes
• Risk factors for diabetes

Alternative Names

Kimmelstiel-Wilson disease; Diabetic glomerulosclerosis; Nephropathy - diabetic

Causes

The exact cause of diabetic nephropathy is unknown, but it is believed that uncontrolled high blood sugar leads to the development of kidney damage. In some cases, your genes or family history may also play a role. Not all persons with diabetes develop this condition.

Each kidney is made of hundreds of thousands of filtering units called nephrons. Each nephron has a cluster of tiny blood vessels called a glomerulus. Together these structures help remove waste from the body. Too much blood sugar can damage these structures, causing them to thicken and become scarred. Slowly, over time, more and more blood vessels are destroyed. The kidney structures begin to leak and protein (albumin) begins to pass into the urine.

Persons with diabetes who have the following risk factors are more likely to develop this condition:

• African American, Hispanic, or American Indian origin
• Family history of kidney disease or high blood pressure
• Poor control of blood pressure
• Poor control of blood sugars
• Type 1 diabetes before age 20
• Smoking

Diabetic nephropathy generally goes along with other diabetes complications including high blood pressure, retinopathy, and blood vessel changes.

References

American Diabetes Association (ADA). Standards of Medical Care in Diabetes - 2008. Diabetes Care. 31:S12-54S.

Inzucchi SE, Sherwin RS. Diabetes Mellitus. In: Goldman L, Ausiello D, eds. Cecil Textbook of Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 248.

American Diabetes Association (2004). Nephropathy in diabetes. Clinical Practice Recommendations 2004. Diabetes Care. 27(Suppl 1): S79–S83.

Parving H, Mauer M, Ritz E. Diabetic Nephropathy. In: Brenner BM. Brenner and Rector's The Kidney. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 36.