Diabetic nephropathy

Diabetic nephropathy is the leading cause of end-stage renal disease in the United States and the largest contributor to the total cost of diabetic ca re. In addition to the development of diabetic nephropathy and end-stage re nal failure, diabetic patients with evidence of albuminuria have a much hig her risk of developing myocardial infarctions, cerebrovascular accidents, s evere progressive retinopathy, and neuropathy. This article characterizes t he clinical and pathologic features of diabetic nephropathy and reviews the major pathogenetic theories that underlie the development of this dreaded complication of diabetes. Widespread screening for this condition and aggre ssive treatment of diabetic nephropathy at early stages of disease are crit ical to diminish the risk of costly late complications.