Recognising the signs of renal damage caused by diabetes enables intervention to slow the condition's progress and minimise complications. David Morris writes.
Diabetic nephropathy is renal damage attributable to diabetes and is the commonest cause of end-stage renal disease in the UK.1 Key risk factors for the development of nephropathy are the duration of diabetes (and not infrequently changes may be present at the time of diagnosis of type 2 diabetes), hypertension and poor glycaemic control. The importance of early recognition is that intervention can halt progression and reduce complications.
On a pathological level, elevated blood glucose levels damage the basement membrane of the glomerular capillaries. Specifically, endothelial damage arises through attachment of glucose to basement membrane proteins and this is accompanied by progressive atherosclerosis.2 The consequence of these changes is a thickened but leaky glomerular basement membrane.
Initially there may be a period of glomerular hyperfiltration but ultimately there is a fall in filtration capacity. The classic trio of clinical observations are characterising diabetic nephropathy is a fall in glomerular filtration rate (GFR), the presence of albuminuria (loss of protein via a leaky glomerular basement membrane) and hypertension (which itself accelerates the nephropathy).