DIABETIC NEPHROPATHY

MADRAS DIABETES RESEARCH FOUNDATION,

Gopalapuram, Chennai

DIRECTOR & DIABETOLOGIST

Dr.Mohan’s DIABETES SPECIALITIES CENTRE

Dr. Mohan’s DIABETES SPECIALITIES CENTRE,

Anna Nagar, Chennai

Dr. Mohan’s DIABETES SPECIALITIES CENTRE, Gopalapuram, Chennai

Dr. Mohan’s DIABETES SPECIALITIES CENTRE, Jubilee Hills, Hyderabad

India

Chennai (Formerly Madras)Hyderabad

Dr.Ranjit Unnikrishnan I., M.D.,

DIABETIC NEPHROPATHY – MAGNITUDE OF THE PROBLEM

Most important cause of morbidity and mortality

in Type 1 diabetes – progression is faster

50% with clinical nephropathy reach ESRD by 10 years

75% with clinical nephropathy reach ESRD by 20 years

In Type 2 diabetes mellitus progression is slower –

20% reach ESRD

About 25 – 50% of all cases of ESRD is due to diabetes

? Racial factors ? Indians / Blacks more susceptible

High economic burden on society

NATURAL HISTORY OF NEPHROPATHY IN TYPE 1 DIABETES

Stage of hyper- filtration

Microalbumi- nuria

Macroalbumi- nuria

Azotemia (Renal failure)

End stage Renal disease

15 - 20 yrs 1 yrs 4 - 5 yrs

Normoalbumi-nuria

MICROALBUMINURIA AND DIABETIC NEPHROPATHY STAGES

Stages Designation Structural GFR UAE BP changes

Stage I Hyperfiltration Glomerular = 150 may N

or Hypertrophy Hypertrophy be

Stage II Normo BM 20% - N N

albuminuria thickness 30%

Stage III Microalbuminuria Further BM GFR 20 - 200

thickness g/min -3mm

of Hg

MICROALBUMINURIA AND DIABETIC NEPHROPATHY STAGES

Stages Designation Structural GFR UAE BP

changes

Stage Overt Clear and >200 Hyper-

IV Proteinuria Pronounced g/min tension

abnormalities Dipstick

positive

Stage End stage Glomerular >200

V Renal closure g/min Hyper-

Disease tension

PREVALENCE OF PROTEINURIACLINIC BASED STUDY ON 1848 TYPE 2 DIABETIC INDIVIDUALS

2.5

6.9

3.8

0 2 4 6 8

Microproteinuria

Macroproteinuria

Proteinuriawithout

retinopathy

PREVALENCE [%]

n=1848

Mohan V et al, Postgrad Med J. 2000;76:569-73.