Abstract
Nephropathy associated with type 1 (insulin-dependent Juvenile onset) or type 2 (noninsulin-dependent, maturity onset) diabetes mellitus is histologically characterized by glomerulosclerosis, hyalinosis of afferent and efferent glomerular arterioles and sometimes pyelonephritis [1–5]. Because diabetic nephropathy with renal failure is considered the cause of death in 42% of the patients below age 20 at the onset of diabetes mellitus, 9% between ages 20 and 39 but only 2.5 or 0.8% between ages 40 and 59 or beyond age 60, respectively [2], it is not surprising that interest in the clinical manifestations and pathophysiology of this complication has centered almost exclusively on type 1, insulin-dependent, juvenile onset diabetes mellitus [6–8]. However, type 2 diabetes mellitus is the most prevalent form of the syndrome, occurring principally after age 40, noninsulin-dependent, without a tendency to ketoacidosis and frequently associated with obesity. Indeed 80% of all diabetic patients show their first symptoms after age 40. Accordingly, this study investigated the clinical manifestations of renal disease in a large number of patients with maturity onset diabetes mellitus. Emphasis in this study was placed on hypertension, frequently observed in these patients, and on quantitative as well as qualitative protein excretion, which provide a useful marker of glomerular or tubule dysfunction when analyzed according to the molecular weight of the various fractions excreted. In this way, the course of renal involvement in maturity onset diabetes mellitus has been assessed and quantified. The results revealed an evolution which is quite different from that seen in juvenile onset, insulin-dependent diabetes mellitus.
Published Version
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