Diabetic Nephropathy; Clinical Characteristics and Treatment Approaches

Abstract

Diabetes mellitus is a major public health problem and its’ prevalance is contuniously rising especially in developed or developing countries. According to World Health Organization (WHO) data the prevalence of diabetes for all age-groups worldwide was estimated to be 2.8% in 2000 and 4.4% in 2030. The total number of people with diabetes is projected to rise from 171 million in 2000 to 366 million in 2030 (1). Despite of improved treatment options for both diabetes mellitus and other associated risk factors, diabetic nephropathy is still a major problem causing increased morbidity and mortality as the increase in total number of diabetic patients finds a reflection in increased prevalence of diabetic patients in end stage renal disease (ESRD) population. There are some studies reporting decreased incidence of diabetic nephropaty in developed countries as a result of better glycemic control and agressive treatment of hypertension with new generation antihypertensives (2). However total number of diabetic nephropathy patients seems to be increasing as a result of increased numbers of diabetic patients and diabetes has become the primary cause of ESRD in the developed countries. Approximately 44% of new patients entering dialysis in the United States are diabetics. In the United States, approximately 20.8 million people, or 7.0% of the population, are estimated to have diabetes, with a growing incidence. Roughly one third of this population, 6.2 million, is estimated to be undiagnosed with type 2 diabetes (3, 4). Similar to these findings prevalence of diabetic nephropahty also increases in in developing countries For example, according to Turkish Society of Nephrology data prevalence of diabetic ESRD patients increased form 7% to 32.5% from 1991 to 2008. A similar trend was also observed for hypertensive nephropathy which raised from 6.3% to 26.8% (5). This hypertensive population is important as according to some previous reports, only one third of essential hypertension patients has normal blood glucose metabolism at diagnosis (6). So it is possible that prevalence of pure diabetic or pure hypertensive nephropathy is lower than predicted but the combination of these two pathological condition is very high in otherwise healthy and ESRD populations.