Renal Disease in Diabetics—which Patients Have Diabetic Nephropathy and What Is Their Outcome?*

Abstract

From August 1974 to January 1985, 53 patients (26 men; seven Maoris) mean age 45 (SD 15) years, with diabetes mellitus for a mean of 12 (SD nine) years had a renal biopsy and were followed. Indications for biopsy were nephrotic syndrome, proteinuria, renal impairment (five) and hematuria (one). Mean plasma creatinine concentration was 0.22 (SD 0.18) mmol/L and protein excretion 3.4 (SD 2.5) g/24 h. Diabetic nephropathy was demonstrated in 39 patients and significantly associated with retinopathy and insulin dependent diabetes mellitus (IDDM). Of the 39 patients followed for 25.7 (SD 22.8) months, 18 had died (nine myocardial infarction, six uremia, two sepsis, one stroke) and nine had begun dialysis. The five-year cumulative renal survival was 28%. The presence of the nephrotic syndrome and the plasma creatinine concentration at presentation were the best predictors of survival. Diabetics with IDDM of 20 years duration, retinopathy and heavy proteinuria, who survive the other complications of their disease, are likely to have diabetic nephropathy requiring renal replacement therapy.

High impact of nephropathy on five‐year mortality rates among patients with Type 2 diabetes mellitus from a multi‐ethnic population in New Zealand

“…The contribution of non-diabetic disease in this cohort is unclear. Although the only study involving biopsies in New Zealand found all Maori patients to have diabetic nephropathy [21], local clinical experience has led to biopsies no longer being routinely taken in South Auckland because of the low yield of non-diabetes-related disease among Polynesians.…”

Reference distributions for alpha2‐macroglobulin: A practical, simple and clinically relevant approach in a large cohort

“…For at least the last two decades, there has been suggestions that a 2 M is increased in certain forms of diabetes mellitus, particularly in the presence of microangiopathic complications (6)(7)(8). This triad of three recognized situationsFhigh a 2 M in the nephrotic syndrome (5), high a 2 M in diabetic renal disease (9,10), and association of the nephrotic syndrome with diabetes mellitus (11)(12)(13)Fthus warrants further investigation using a 2 M as a tool for diagnosis and monitoring of diabetic patients.…”

Ethnic differences in the natural progression of nephropathy among diabetes patients in New Zealand: hospital admission rate for renal complications, and incidence of end-stage renal disease and renal death

“…Incidence rates and hazard ratios for end-stage renal disease (ESRD) among Maori diabetes patients have not been estimated previously. Available studies on nephropathy among Maori diabetes patients have limitations because they were cross-sectional, looked at prevalence [3,4], included dialysis and transplant registry patients only [5][6][7][8], or included existing renal disease patients only [9]. The Waikato Regional Diabetes Service (WRDS) provides specialist diabetes services and retinal screening for people in the area covered by the Waikato District Health Board (DHB).…”