Initiating factors and progression promoters in diabetic nephropathy

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Factors leading to initiation and those determining rate of progression of diabetic renal disease are gaining increasing recognition.

Both development and early progression of diabetic nephropathy are most likely to occur following years of poor

Cumulative incidence of coronary heart disease in Type 1 diabetic patients with and without proteinuria

Nephropathy—initiating factors and progression

promoters

Initiating factors

Progression promoters

• Persistently poor

• Blood pressure

diabetic control

• Proteinuria

Hypertension in

• Persistently poor

Type 2 diabetes

diabetic control

• Genetic factors

• Dyslipidaemia

• Genetic factors

• Smaller kidneys

(or glomeruli)

• Smoking

• High dietary protein

diabetic control; tight control over a decade both delays onset of the disease and slows progression chiefly of its early phase, although there is some effect in established disease as well. There is also a familial propensity to nephropathy in both Type 1 and Type 2 diabetes, although the precise genetic factors responsible have not been identified.

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