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Diabetic Nephropathy: Hemodynamic Basis and Implications for Disease Management
- Robert H. Noth, MD;
- Andrzej S. Krolewski, MD, PhD;
- George A. Kaysen, MD, PhD;
- Timothy W. Meyer, MD; and
- Morris Schambelan, MD
Excerpt
New evidence shows that systemic and intrarenal hemodynamic abnormalities are major factors in the initiation and progression of diabetic nephropathy. Genetic predisposition to elevated systemic blood pressure may contribute to its development. Glomerular vasodilation and hyperfiltration, mediated in part by prostaglandins, may play a role in glomerular damage early in the course of diabetes, but clinical studies are limited. The development of more sensitive assays for albuminuria now allows early diagnosis of incipient nephropathy in the "microalbuminuria" phase. Treatment during this phase with antihypertensive agents, including angiotensin-converting enzyme inhibitors, or with dietary protein restriction, can decrease the degree of albuminuria,
This 100-word excerpt has been provided in the absence of an abstract.
Acknowledgments
Acknowledgments: The authors thank Ann Wyant Halsted for editorial assistance.
Article and Author Information
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From the Interdepartmental Dean's Conference arranged by the Department of Medicine, University of California, Davis, School of Medicine, Davis, California, and the Veterans Administration Medical Center, Martinez, California. Michael G. Geokas, MD, PhD, is permanent chairman and organizer of these conferences.
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Authors who wish to cite a section of the conference and specifically indicate its author can use this example for the form of the reference:
Krolewski AS. The natural history of diabetic nephropathy in type I diabetes and the role of hypertension, pp 795-798. In: Noth RH. Diabetic Nephropathy: Hemodynamic Basis and Implications for Disease Management. Ann Intern Med. 1989;110:795-813.
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Grant Support: Partial support by a grant from the Pennwalt Corporation, Rochester New York; grants from the Wilson Foundation, Rochester, NY; Biomedical Research Support grant DHHS RR05673-18; Diabetes Endocrinology Research Center grant DHHS DK36836-01 from the National Institutes of Health to Dr. Krolewski; USPHS grant HL 11046-23 from the NHLBI to Dr. Schambelan; and the Veterans Administration Merit Review.
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Requests for Reprints: Michael C. Geokas, MD, PhD, University of California Service, Martinez Veterans Administration Medical Center (612/111), 150 Muir Road, Martinez, CA 94553.
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Current Author Addresses: Drs. Noth and Kaysen: Medicine Service, Veterans Administration Medical Center, 150 Muir Road, Martinez, CA 94553.
Dr. Krolewski: Joslin Diabetes Center, Research Division, 1 Joslin Place, Boston, MA 02215.
Dr. Meyer: Nephrology 11 IR, Veterans Administration Medical Center, 3801 Miranda Avenue, Palo Alto, CA 94304.
Dr. Schambelan: San Francisco General Hospital, 1001 Potrero Avenue, Bldg 100, Ward 18, San Francisco, CA 94101.
- ©1989 American College of Physicians
