There has been some discussion about the significance of non-diabetic renal disease in diabetic patients. In my experience this is quite rare, but selected studies from nephrology departments show that the problem may be more common there. However, it is now generally accepted that non-diabetic renal disease is not more common in diabetic patients than in the background population (4). It has taken many years to reach this understanding. Renal biopsies are very rarely indicated.
The understanding of diabetic renal disease has been distorted by the following hypotheses:
1. It has been claimed that high blood pressure would be essential to maintain renal function—a prevailing concept in the United States for many years (24, 25).
2. It has also been alleged that hyperglycemia is not important in the genesis of diabetic renal disease—clearly an unsound and faulty statement (24).
3. It has also been claimed that genetic factors are decisive in determining renal disease—this has never been adequately substantiated (26).
4. The idea that non-diabetic renal disease like glomerulonephritis was important also hindered our understanding for many years (27).
It is now clear that normalizing or even "sub-normalizing" blood pressure is essential. The exception seems to be for the patients with advanced renal disease where a U-formed
TABLE 3 Optimal Blood Pressure Level in Diabetic Patients
Without nephropathy < 130/80
With nephropathy Somewhat lower
curve has been documented in the IDNT-study in type 2 diabetes (30). It is also clear that hyperglycemia is a main risk factor in the genesis of diabetic renal disease. Genetic factors have not been identified and there is no reason to believe that genetic factors are decisive although they may modulate the development (26). Combining the effect of high blood pressure and hyperglycemia may be sufficient to explain the development of renal disease. Hall emphasizes that BP-lowering can reduce progression of diabetic renal disease—an observation made more than 25 years ago (25).
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All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.