Slide 9 of 30
Notes:
The natural history of diabetic nephropathy in type 1 diabetes is pretty well established.
It is believed that nephropathy in type 2 patients follows a similar course.
Stage 1 - is characterized by hyperfiltration which is thought to be secondary to hyperglycemia. The changes that occur here can be reversed by correction of the hyperglycemia. Until recently it was unclear that glomerular hyperfiltation and an increase in GFR occurred in type 2 diabetes. It still is not known if tissue hypertrophy corrects with treatment of the hyperglycemia. Type 2 diabetes also differs in that microalbuminuria may be found early in the course. This may be a complication of untreated hyperglycemia, or evidence that microalbuminuria may be caused by other mechanisms in type 2 diabetics. These mechanism have not been worked out but possibly could be related to a prediabetic state, the insulin resistance syndrome, a generalized vasculopathy, or side effect of hypertension.
Unlike type 1, 1/3 of patients with type 2 diabetes has hypertension at the time of diagnosis.
Stage 2 - histologic changes are occuring in the kidney even though the condition is not clinically recognizable at this stage.
Stage 3 - Abnormal amounts of albumin are recognized in type 1 diabetes, this is associated with an increase in blood pressure.
