THE COURSE OF KIDNEY-FUNCTION IN TYPE-2 (NON-INSULIN-DEPENDENT) DIABETIC-PATIENTS WITH DIABETIC NEPHROPATHY

We evaluated the impact of some putative progression promoters on kidn ey function in albuminuric Type 2 (non-insulin-dependent) diabetic pat ients with biopsy-proven diabetic glomerulosclerosis. Twenty-six patie nts (1 female) with a mean age of 52 (standard error 2) years and a kn own mean duration of diabetes of 9 (1) years were followed-up prospect ively for a mean of 5.2 (range 1.0-7.0) years. Twenty-one patients rec eived antihypertensive treatment. During the observation period the gl omerular filtration rate decreased from 83 (24-146) to 58 (2-145) ml.m in-1 .1.73 m-2 (mean (range)) (p < 0.001). The mean rate of decline in glomerular filtration rate was 5.7 (-3.5 to 22.0) ml/min per year. Al buminuria increased from 1.2 (0.3-7.2) to 2.3 (0.4-8.0) g/24 h (geomet ric mean (range)) (p < 0.001). Arterial blood pressure remained unchan ged: 162/93 (SE 4/3) and 161/89 (4/2) mm Hg. Univariate analysis showe d the rate of decline in glomerular filtration rate to correlate with systolic blood pressure (r = 0.71, p < 0.001), mean blood pressure (r = 0.56, p < 0.005), albuminuria (r = 0.58, p < 0.005) and the initial glomerular filtration rate (r = -0.49, p < 0.02). The rate of decline in glomerular filtration rate did not correlate significantly with die tary protein intake, total cholesterol, high-density lipoprotein chole sterol or HbA1c. Three patients died from uraemia and four patients di ed from cardiovascular disease. Two patients required renal replacemen t therapy at the end of the observation period. Our prospective observ ational study revealed that one-fifth of the patients developed end-st age renal failure during the 5-year observation period. The decline in glomerular filtration rate varied considerably between patients. Incr ease in arterial blood pressure to a hypertensive level is an early fe ature of diabetic nephropathy. Elevated systolic blood pressure accele rates the progression of diabetic nephropathy in Type 2 diabetic patie nts.