A Historical Overview of Diabetic Nephropathy

Abstract

Excessive urine output is one of the oldest diseases to be recognized that was dubbed diabetes in the first century B.C. Its clinical features and fatal outcome were described by the second century A.D., when it was attributed to a weakness in the retentive faculties of the kidney by Galen (129–200). Thus, it came to be considered a disease of the kidneys well into the nineteenth century. The sweet taste of diabetic urine was described by most ancient authors but attributed to the non-specific passage of absorbed water and nutrients, alongside with sweet ones, into the urine. In 1674, Thomas Willis (1621–1675) was the first to argue that the sweetness of the urine was specific to the disease and likely due to a sweetness of the blood. It would be another century before Matthew Dobson (1673–1784) documented in 1776 the hypothesis of Willis showing that the sweetness of the urine was preceded by an increase in the sweetness of the blood, while his collaborator William Cullen (1710–1780) termed the disease diabetes mellitus to differentiate it from the insipid tasting urine he had observed in some polyuric cases. The experimental production of diabetes mellitus in pancreatectomized dogs by Oskar Minkowski (1858–1931) and Josef von Mering (1849–1908) in 1889 and the subsequent isolation of insulin from the pancreas by Frederick Banting (1891–1941) and Charles Best (1899–1078) in 1922 established diabetes as an endocrine disorder. The stage of diabetes as a kidney disease was now over, but that of diabetes as a cause of kidney disease was yet to come. Diabetes as a cause of end-stage kidney disease was first documented by Paul Kimmelstiel (1900–1970) and Clifford Wilson (1906–1997) in 1936 and extensively studied shortly thereafter. The availability of kidney biopsy and refinements in the quantification of albuminuria were instrumental in defining the course and prevalence of what was then termed diabetic nephropathy. The increased prevalence of obesity and of improved longevity over the past few decades account for the current ravaging worldwide epidemic of diabetic kidney disease.