MCV/Q, Medical College of Virginia Quarterly

MCV/Q, Medical College of Virginia Quarterly

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Diabetic Nephropathy

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MCV/Q, Medical College of Virginia Quarterly





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Any discussion of morbid events in diabetes is going to emphasize cardiovascular and peripheral vascular problems. Renal disease accounts for a relatively small percentage of the mortality in diabetes; yet the overall incidence of diabetes mellitus in the population so greatly exceeds that of the various types of glomerulonephritis that it has become one of the most common causes of end-stage renal failure in this country. It is difficult to assign exact numbers because the figures in the medical literature vary considerably; however, it is estimated that in the United States today there are some 10 million people who are known to be diabetic, who would be found to be diabetic if tested, or who during the course of their lives will develop overt diabetes. In autopsy series of diabetics the prevalence of glomerulosclerosis has varied from 15% to 82%, with a mean of approximately 30%. This figure will vary depending on how carefully the kidneys are studied, particularly with respect to the use of special stains for identifying glomerulosclerosis; the incidence will also increase with the proportion of juvenile to adult onset diabetics included in the sample. Renal failure is listed as the cause of death of 6% to 12% of diabetics, and its incidence is increased seventeenfold in the diabetic population as compared to the nondiabetic. These figures are probably applicable to those diabetics who have many complications and who require referral to major medical centers for treatment. In terms of the general diabetic population renal failure is probably in the range of 1% to 2%. This means that the prevalence of glomerulosclerosis is severalfold higher than the prevalence of renal failure, and that simply finding the lesion on biopsy does not indicate that kidney function itself has been impaired or that there will be any abnormalities present on urinalysis. As a cause of end-stage renal failure, diabetes now accounts for some 15% to 25% of all new cases.


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