Progression of renal failure in diabetic nephropathy

The onset of renal damage in diabetes mellitus may be influenced by several factors which largely result from genetic predisposition, hereditary facto rs and the early appearance of microalbuminuria and/or systemic hypertensio n. Most of these factors are also implicated in the progression of nephropa thy from microalbuminuria to overt proteinuria and to endstage renal failur e (ESRF). Over the last few years, the role of hyperglycaemia has emerged a s critical in mediating the progressive renal damage in diabetes. However, hyperglycaemia leads to increased formation of glycated proteins which may act as promoters of progression by localizing in renal tissue. In addition, hyperglycaemia may have a synergistic effect with some other risk factors, such as growth factors and the renin-angiotensin system, in accelerating r enal deterioration.