Generality
Diabetic nephropathy is a disease that deteriorates the renal function of some diabetic patients rather slowly but irreversibly, especially those in which the disease has existed for many years. Indicatively, this complication affects 30-40% of type 1 diabetics and 10-20% of type 2 diabetics.
Symptoms
To learn more: Diabetic Nephropathy Symptoms
Diabetic nephropathy is described as a clinical syndrome characterized by:
- persistent microalbuminuria (between 50 and 300 mg / day)
- slow and gradual decline in renal function with tendency to proteinuria and renal failure
- hypertension
- high risk of cardiovascular morbidity and mortality
The clinically established form generally appears after about 15-25 years from the beginning of diabetes.
Incidence
Diabetic nephropathy is an expression of poor glycemic control over time; for this reason, in the various scientific texts and in the same epidemiological studies there are important differences on the real incidence of this complication in the diabetic population.
The recognition of the constant increase in cases of illness is unanimous: due to the spread of a sedentary lifestyle and excessive caloric intake, it is estimated that the worldwide diabetic population will increase from 154 million people registered in 2001 to 285 million in 2025. With the increase in the average life span, it should also be borne in mind that, since type 2 Diabetes Mellitus is a disease with particularly slow and progressive evolution, at the time of diagnosis many patients already present a microalbuminuria or more rarely a full-blown diabetic nephropathy. This underlines the importance of periodic glycemic controls even in the apparently healthy population, from a young age.
Beyond the numbers, it is important to stress that diabetic nephropathy is the leading cause of chronic renal failure in the United States.
Causes and risk factors
The probability of developing this complication is proportional to the duration of diabetes (both insulin-dependent and insulin-independent): in other words, the longer the person suffers from diabetes, the greater the risk of developing a diabetic nephropathy.
The risk also increases in relation to the quality of glycemic control : therefore, the patients most exposed to the risk of developing diabetic nephropathy are those who are less attentive to their diet, their lifestyle and the correct use of the prescribed drug therapy.
Once established, the rate of progression of diabetic nephropathy towards renal failure correlates above all to the values of arterial pressure: the more these are elevated, the faster and more severe the evolution of nephropathy towards renal insufficiency results. A similar argument can be made for cholesterol values. Diabetic patients suffering from hypertension and hypercholesterolemia are therefore more at risk of a rapid worsening of the disease after its onset.
Smoking, on the other hand, seems to favor both the appearance of diabetic nephropathy and its evolution towards chronic renal failure.
Alongside all these correctable factors (hyperglycemia, hypercholesterolemia, hypertension, tobacco habit) there is an innate non-modifiable component, namely the individual genetic predisposition; we have seen, for example, that the risk of onset of nephropathy and its evolution is greater when the diabetic has a family history of diabetes, hypertension or cardiovascular disease. American Indians, Orientals and African Americans are also more exposed to the risk of diabetic nephropathy than Caucasian Americans.
But what exactly does kidney failure mean? This is a disease in which the kidneys are no longer able to perform their functions; consequently there is a significant accumulation of waste substances normally eliminated with urine. The toxicity of these substances compromises the functionality of the entire organism and, in the absence of a medical intervention, causes its death.
