ACQUIRED OLIGONEPHROPATHY AND DIABETIC NEPHROPATHY

Congenital or acquired nephron number reduction and diabetes mellitus both induce hyperfiltration and intrarenal hypertension, These hemodyn amic factors have been suggested to play an important role in the init iation and progression of diabetic and nondiabetic glomerulopathies, I n a prevalence cohort of all 50 albuminuric (greater than or equal to 300 mg/24 hr), non-insulin-dependent diabetic mellitus (NIDDM) patient s (aged <66 years) attending a diabetic clinic during 1987, we identif ied four patients with acquired oligonephropathy who had developed dia betic nephropathy, Three patients only had a single functioning kidney (nephrectomy in two cases), and the remaining patient had unilateral severely reduced kidney function and elevated plasma renin concentrati on, These patients represent 8% of our NIDDM population with albuminur ia, and are the only patients in our NIDDM population younger than 66 years (n = 363) known to have single kidneys, However, systematic reno graphy screening was not performed. During the observation period, whi ch ranged from 16 to 100 months, albuminuria increased from 2.3 g/24 h r (range, 1.2 to 3.4 g/24 hr) to 3.2 g/24 hr (range, 0.7 to 9.4 g/24 h r), glomerular filtration rate decreased to 6 mL/min/yr (range, 4 to 1 2 mL/min/yr), and blood pressure remained stable at 142/92 mm Hg, Thre e patients received antihypertensive medication, Two of the patients d ied after 16 and 26 months of observation, respectively, due to acute myocardial infarction and stroke, The results of our study of NIDDM pa tients support the concept that reduced nephron number predisposes pat ients to the development of diabetic nephropathy. (C) 1995 by the Nati onal Kidney Foundation, Inc.