ABSTRACT
Natural history of nephropathy in type II diabetes Although there are some minor differences in the natural history of diabetic nephropathy in type I and type II diabetes there are many similarities.2 In particular, the classification of nephropathy by Mogensen into a number of
distinct phases can, in general, be used for both forms of diabetes.3 The initial changes, which include glomerular hyperfiltration, have been shown to occur in type II diabetes although not as prominently as reported in type I.4 This is followed by a silent phase which is associated with subtle morphological changes including glomerular basement membrane thickening, glomerular hypertrophy, mesangial expansion and modest expansion of the tubulo-interstitium. This is followed by a phase known as microalbuminuria or incipient diabetic nephropathy.5 This is characterised by a modest increase in excretion of albumin into the urine. On renal biopsy, there is evidence of significant glomerular injury,6 although in type II diabetic patients the pattern is more heterogenous, suggesting a more complex pathogenesis than in type I diabetes.7 Microalbuminuria is commonly associated with other diabetic complications as well as with cardiovascular disease.8 Multiple explanations have been provided for the relationship between microalbuminuria and cardiovascular disease. These include common pathogenetic pathways or risk factors such as endothelial dysfunction,9 hypertension, abnormalities in lipid metabolism, insulin resistance,10 smoking and metabolic pathways linked to glucose or glucose-derived proteins such as advanced glycated lipoproteins.
