Diabetic nephropathy: Scope of the problem

Abstract

Diabetic nephropathy is a common complication of diabetes and the leading cause of chronic kidney disease in the developed world. Approximately 40 % of persons with type 2 diabetes develop diabetic nephropathy (albuminuria and/or decreased glomerular filtration rate). Even mild degrees of albuminuria and decrease in glomerular filtration rate are associated with significantly increased risks of cardiovascular disease, end-stage renal disease, and premature deaths. The prevalence of diabetic nephropathy in the US adult population aged 20 years and older is 3.3 % and increases with age (10.7 % among individuals aged 65 years and older). Increase in the prevalence of diabetic nephropathy is directly related to the increased prevalence of diabetes, which is largely driven by increasing obesity and metabolic syndrome. Both obesity and metabolic syndrome can directly contribute to the progression of kidney disease. These disorders likely interact with diabetes to exacerbate the kidney damage. In addition, increases in diabetic nephropathy prevalence are the largest for persons aged 65 years or older among whom diabetic nephropathy is most common. The prevention and treatment of diabetic nephropathy in older patients may require specific strategies. This chapter reviews the epidemiology of diabetic nephropathy, interrelationship between obesity, metabolic syndrome and diabetic nephropathy, and special challenges of diabetic nephropathy in the elderly.