Les facteurs de progression de la néphropathie diabétique : prise en charge et évolution

Abstract

The diabetic nephropathy is among the first causes of end stage renal disease worldwide. However, the diabetics are often lately refered to the nephrologists. The goal of our study is to determine the stage of the diabetic nephropathy, its risk factors and to appreciate its evolution after a nephrology management in Morocco. Prospective study including 728 patients diabetic type 2 addressed for a nephrologic follow up between January 2000 and December 2007. We evaluated the stage of diabetic nephropathy by the dosage of the urinary albumin excretion of 24 hours and the estimation of the renal function by the creatinine clearance. Four stages have been distinguished: negative microalbuminuria, positive microalbuminuria, macroalbuminuria and renal failure. After the instauration of the measures of nephroprotection, we appreciated the evolution of this diabetic nephropathy after a minimum follow-up of six months. The mean age of our patients was of 61,8 years. At the first consultation, 68,9% of patients had a renal failure. The diabetes duration was of 13,8 years. The unbalanced diabetes was noted at 68,7% of the patients. The risk factors of the renal failure were age, systolic arterial tension, retinopathy diabetic and anemia. After a mean follow-up of 22,4 months, the urinary albumin excretion became negative in 42,6% of the patients. The deterioration of the renal function was slow (creatinine clearance: 52,2ml versus 45,5ml/min/1,73m(2)). The majority of our patients had renal failure at the first consultation, showing the late referal of the diabetics to the nephrologists, complicating their management. The early screening would permit to assure the nephroprotection.