The Role Of Proteinuria In The Diagnosis And Treatment Of Type Diabetes

William F. Keane and Paulette A. Lyle

Merck & Co., Inc. Whitehouse Station, New Jersey, USA

Renal and cardiovascular diseases associated with type 2 diabetes present significant burdens to patients and health care systems, and are increasing at epidemic proportions. The prevalence of type 2 diabetes and the concurrent end-organ diseases are increasing at an alarming rate in world populations. The 1997 prevalence of type 2 diabetes is predicted to nearly double by the year 2010 [1]. The microvascular complications of diabetes are currently estimated to be responsible for over 40% of newly diagnosed cases of nephropathy [2,3].

Diabetic nephropathy as a sequela to type 2 diabetes has become the leading cause of end-stage renal disease. Diabetic nephropathy is approximately twice as common a cause of end-stage renal disease than is nephropathy caused by hypertension or primary glomerular diseases. Mortality among patients receiving chronic hemodialysis is estimated to be 21-25% per year, with the majority of deaths secondary to cardiovascular causes. Even though current recommendations for diabetics include the need for early screening for microalbuminuria, these patients who are at high risk for the development of nephropathy often go unidentified. At the time of diagnosis of type 2 diabetes, approximately 30% of the patients will already have albumin or protein in the urine: 75% will have microalbuminuria (30-300 mg/24 hr), and 25% will have overt proteinuria (> 300 mg/24 hr). Persistent albuminuria indicates underlying structural changes in the kidney consistent with diabetic nephropathy [4-8]. Microalbuminuria per se may be a silent harbinger of future vascular disease.

Mogensen CE (ed.) THE KIDNEY AND HYPERTENSION IN DIABETES MELLITUS. Copyright© 2004 by Martin Dunitz, a member of the Taylor & Francis Group, plc. All rights reserved.

Prevention of albuminuria and delaying the progression of nephropathy must be major goals of any treatment strategy developed for the diabetic patient - a treatment strategy that must include lowering of blood pressure and glucose, as well as the prevention or reduction of proteinuria [9-12].

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