ABSTRACT
Geoffrey Boner, Paul G McNally, Mark Cooper Diabetic complications Group, Baker Heart Research Institute, Commercial Rd, Prahran 3181, VIC Australia
The deleterious effects of systemic blood pressure on glomerular structure were reported thirty years ago in a patient with type 2 diabetes mellitus (DM2) and unilateral renal artery stenosis, in which characteristic nodular diabetic glomerulosclerosis was present in the non-ischemic kidney only [1]. It is only over the past few years that attention has been paid to the impact of antihypertensive treatment on renal injury in patients with DM2 [2-6]. This is despite the fact that the cumulative incidence of persistent proteinuria and microalbuminuria in DM2 patients is very similar to that in type 1 diabetes mellitus (DM1) patients [7]. The clinical relevance of these figures is reflected by statistics, which show that more than 30% of patients entering dialysis programs in most developed nations have diabetic nephropathy, with most of them having DM2 [8]. The data from the United Kingdom Prospective Diabetes Study (UKPDS) have been analyzed in order to delineate the progression of nephropathy in DM2 [9]. The authors have shown that there is a steady progression of renal involvement in patients with DM2, so that 10 years after diagnosis, 24.9% of patients have microalbuminuria, 5.3% have macroalbuminuria and 0.8% have developed an elevated serum creatinine or were on renal replacement therapy.
