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Nephropathy in diabetes mellitus


, : Nephropathy in diabetes mellitus. Cardiovascular Medicine 2(3): 239-252

As a result of insulin therapy, diabetics now live long enough to develop frequent and often devastating systemic vasculopathic complications, of which diabetic nephropathy may be the most debilitating and life-limiting. Renal disease accounts for about 20% of all deaths in the diabetic population below the age of 40. While the prevalence, morbidity and mortality of diabetic nephropathy are self-evident, understanding the cause(s), formulating a therapeutic regimen and counseling the patient and his family require time, data and patience. Controversy exists as to whether the microangiopathy is genetically determined or a result of the altered intermediary metabolism in diabetes and the perturbation in the biochemical composition of the glomerular basement membrane. The diabetic with end-stage renal failure is more difficult to rehabilitate with maintenance hemodialysis and renal allotransplantation than the nondiabetic uremic. The diabetic managed by long-term hemodialysis is plagued by the coincident progression of retinopathy and angina, among other serious complications. Similarly, the diabetic transplant recipient sustains more infections and other complications, both before and after the transplant. Moreover, the observation that normal kidneys transplanted into diabetics are beginning to show diabetic changes indicates the need for additional transplants. The ultimate solution will not be possible until the internal milieu can be corrected by a bionic pancreas or islets of Langerhans transplant.

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