Timecourse Of Renal Functional Alterations In Td

The renal functional complications of T1D are complex and evolve markedly with duration of the disease. The early stage of T1D is characterized by substantial increases in renal blood flow and glomerular filtration rate (GFR). In humans, diabetic hyperfiltration persists for 5-10 yr, before waning to a normal and eventually subnormal GFR. The onset of diabetic nephropathy (DN) is heralded by the appearance of

From: Contemporary Diabetes: The Diabetic Kidney Edited by: P. Cortes and C. E. Mogensen © Humana Press Inc., Totowa, NJ

microalbuminuria and albuminuria. Advanced DN is characterized by proteinuria, further deterioration of renal function and GFR, glomerulosclerosis, and interstitial fibrosis. This progression is exacerbated by hypertension, underscoring the vascular basis of the process. Maneuvers that limit or prevent development of diabetic hyperfiltration (e.g., by decreasing efferent arteriolar resistance, as provided by angiotensin-converting enzyme (ACE) inhibitors) delay or prevent onset of DN, suggesting that the hyperfiltration occurring early in T1D engenders eventual development of DN.

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