Development of diabetic nephropathy in Japanese patients with insulin-dependent diabetes mellitus: Tokyo women's medical college epidemiologic study

Abstract

To clarify the development of diabetic nephropathy in Japanese insulin-dependent diabetes mellitus (IDDM), 373 patients with IDDM who had no proteinuria at the first visit to our Diabetes Center were evaluated. The incidence of persistent proteinuria increased rapidly between 10 and 19 years of diabetes duration, and only a few new cases occurred thereafter. Patients whose ages at onset of IDDM were 9–17 years ( n = 167) and 18–29 years ( n = 90) had rapid development of persistent proteinuria compared to the 0 to 8-year group ( n = 116) ( p < 0.02 and p < 0.003, respectively). Females ( n = 233) developed persistent proteinuria to a greater extent until 24 years of diabetes duration than males ( n = 140) ( p = 0.17). Development of proteinuria did not vary according to calendar year of diagnosis of IDDM or diabetes duration at the first visit. Renal insufficiency (serum creatinine of 2.0 mg/dL or greater) followed the onset of proteinuria; 60% of the patients with the onset of IDDM between 1951 and 1969 developed renal insufficiency 10 years after the onset of proteinuria, whereas 30% of patients with the onset of IDDM after 1970 developed this condition. Development of renal insufficiency did not vary according to sex, age at onset of IDDM, or age at onset of proteinuria. Renal failure requiring dialysis therapy occurred within 4 years after renal insufficiency. In conclusion, development of diabetic nephropathy in Japanese IDDM exhibits three stages. The onset of proteinuria appears to be influenced by age at onset of IDDM and sex. Incidence of renal insufficiency seems to be decreasing in patients with recent onset of IDDM, however, once it occurs, renal failure requiring dialysis therapy develops within 4 years.