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DOI: 10.1055/s-2002-23100
Nephropathy in Type 1 Diabetes
Publication History
Publication Date:
25 March 2002 (online)

ABSTRACT
Nephropathy is the major life-threatening complication of type 1 diabetes. It is due to the adverse effects of glucose-induced preglomerular vasodilation on glomerular hemodynamics. Glomerulosclerosis is initiated early in the course of diabetic nephropathy by exacerbated expression of cytokines like tumor growth factor β1. Not all type 1 diabetes patients are at risk of nephropathy, probably because some polymorphisms in the various factors involved in its pathogenesis can modulate the course of this disease from one individual to another. Blocking the course of nephropathy by blockers of the renin-angiotensin system relies on solid pathophysiological hypotheses and has proved to be efficacious for improving the prognosis of type 1 diabetes nephropathy.
KEYWORD
Type 1 diabetes - nephropathy - glomerular disease - albuminuria - angiotensin converting enzyme - genetics - transforming growth factors β1
REFERENCES
- 1 Kimmelstiel P, Wilson C. Intercapillary lesions in the glomeruli of the kidney. Am J Pathol . 1936; 12 83-97
- 2 Østerby R, Gundersen H J. Glomerular size and structure in diabetes mellitus 1. Early abnormalities. Diabetologia . 1975; 11 229-239
- 3 Mauer S M, Steffes M W, Ellis EN Sutherland D ER, Brown D M, Goetz F C. Structural-functional relationship in diabetic nephropathy. J Clin Invest . 1984; 74 1143-1155
- 4 Lane P H, Steffes M W, Mauer S M. Glomerular structure in IDDM women with low glomerular filtration rate and normal urinary albumin excretion. Diabetes . 1992; 41 581-586
- 5 Bangstad H J, Østerby R, Dahl-Jorgensen K, Berg K J, Hartmann A, Hanssen K F. Improvement of blood glucose control in IDDM patients retards the progression of morphological changes in early diabetic nephropathy. Diabetologia . 1994; 37 483-490
- 6 Rudberg S, Østerby R, Bangstad H J, Dahlquist G, Persson B. Effect of angiotensin converting enzyme inhibitor or beta-blocker on glomerular structural changes in young microalbuminuric patients with type I (insulin-dependent) diabetes mellitus. Diabetologia . 1999; 42 589-595
- 7 Mogensen C E, Christensen C K, Vittinghus E. The stages in diabetic renal disease. Diabetes . 1983; 32 64-78
- 8 Mogensen C E, Christensen CK Predicting diabetic nephropathy in insulin-dependent patients. N Engl J Med . 1984; 311 89-93
- 9 Viberti G C, Keen H, Wiseman M J. Raised arterial pressure in parents of proteinuric insulin-dependent diabetics. BMJ . 1987; 295 515-517
- 10 Norgaard K, Feldt-Rasmussen B, Borch-Johnsen K, Saelan H, Deckert T. Prevalence of hypertension in type 1 (insulin-dependent) diabetes mellitus. Diabetologia . 1990; 33 407-410
- 11 Mathiesen E R, Ronn B, Jensen T, Storm B, Deckert T. The relationship between blood pressure and urinary albumin excretion in the development of microalbuminuria. Diabetes . 1990; 39 245-249
- 12 Hansen K W, Mau Pedersen M, Marshall S M, Christiansen J S, Mogensen C E. Circadian variation of blood pressure in patients with diabetic nephropathy. Diabetologia . 1992; 35 1074-1079
- 13 Bigazzi R, Bianchi S, Baldari D, Sgherri G, Baldari G, Campese V M. Microalbuminuria in salt-sensitive patients: a marker for renal and cardiovascular risk factors. Hypertension. 199; 23 195-199
- 14 Berrut G, Hallab M, Bouhnick B, Chameau A M, Marre M, Fressinaud P h. Value of ambulatory blood pressure monitoring in type I (insulin-dependent) diabetic patients with incipient diabetic nephropathy. Am J Hypertens . 1994; 7 222-227
- 15 Mogensen C E. Glomerular filtration rate and renal plasma flow in short-term and long-term juvenile diabetes mellitus. Scand J Clin Lab Invest . 1971; 28 91-100
- 16 Kohner E M, Hamilton A M, Saunders S J, Sutcliffe B A, Bulpitt C J. The retinal blood flow in diabetes. Diabetologia . 1975; 11 27-33
- 17 Williamson J R, Chang K, Frangos M. Hyperglycemic pseudohypoxia and diabetic complications. Diabetes . 1993; 42 801-813
- 18 Tooke J E. Microvascular function in human diabetes. A physiological perspective. Diabetes . 1995; 44 721-726
- 19 Brenner B M. Hemodynamically mediated glomerular injury and the progressive nature of kidney disease. Kidney Int . 1983; 23 617-655
- 20 Parving H H, Hommel E. Prognosis in diabetic nephropathy. BMJ . 1989; 299 230-233
- 21 Thomsen O F, Andersen A R, Christiansen J S, Deckert T. Renal changes in long-term type 1 (insulin-dependent) diabetic patients with and without clinical nephropathy: a light microscopic, morphometric study of autopsy material. Diabetologia . 1984; 26 361-365
- 22 Mogensen C E, Chachati A, Christensen C K. Microalbuminuria: an early marker of renal involvement in diabetes. Uremia Invest. 1985-86; 9 85-95
- 23 Bouhanick B, Berrut G, Chameau A M. Predictive value of testing random urine sample to detect microalbuminuria in diabetic subjects during outpatient visits. Diabete Metab . 1992; 18 54-59
- 24 Levey A S, Madaio M P, Perrone R D. Laboratory assessment of renal disease: clearance, urinalysis, and renal biopsy. In: Brenner BM, Rector FC Jr, eds. The Kidney. Philadelphia, PA:WB Saunders Co 1991: 919-968
- 25 Cockfroft D W, Gault M H. Prediction of creatinine clearance from serum creatinine. Nephron . 1976; 16 31-41
- 26 Krolewski A J, Warram J H, Rand L I, Kahn C R. Epidemiologic approach to the etiology of type I diabetes mellitus and its complications. N Engl J Med . 1987; 317 1390
- 27 Rossing P, Rossing K, Jacobsen P, Parving H H. Unchanged incidence of diabetic nephropathy in IDDM patients. Diabetes . 1995; 44 739-743
- 28 Bojestig M, Arnqvist H J, Hermansson G, Karlberg B E, Ludvigsson J. Declining incidence of nephropathy in insulin-dependent diabetes mellitus. N Engl J Med . 1994; 30 15-18
- 29 Kofoed-Enevoldsen A, Borch-Johnsen K, Kreiner S, Nerup J, Deckert T. Declining incidence of persistent proteinuria in type 1 (insulin-dependent) diabetic patients in Denmark. Diabetes . 1987; 36 205-209
- 30 Seaquist E R, Goetz F C, Rich S, Barbosa J. Familial clustering of diabetic kidney disease: evidence for genetic susceptibility to diabetic nephropathy. N Engl J Med . 1989; 320 1161-1165
- 31 Borch-Johnsen K, Norgaard K, Hommel E. Is diabetic nephropathy an inherited complication?. Kidney Int . 1992; 41 719-722
- 32 Quinn M, Angelico M C, Warram J H, Krolewski A S. Familial factors determine the development of diabetic nephropathy in patients with IDDM. Diabetologia . 1996; 39 940-945
- 33 Earle K, Walker J, Hill C, Viberti G C. Familial clustering of cardiovascular disease in patients with insulin-dependent diabetes and nephropathy. N Engl J Med . 1992; 326 673-677
- 34 Pettit D J, Saad M F, Bennett P H, Nelson R G, Knowler W C. Familial predisposition to renal disease in two generations of Pima Indians with 2 (noninsulin-dependent) diabetes mellitus. Diabetologia . 1990; 33 438-443
- 35 Borch-Johnsen K, Kreiner S. Proteinuria: value as predictor of cardiovascular mortality in insulin-dependent diabetes. BMJ . 1987; 294 1651-1654
- 36 Mogensen C E. Microalbuminuria predicts clinical proteinuria and early mortality in maturity-onset diabetes. N Engl J Med . 1984; 310 356-360
- 37 Kannel W B, Stampfer M J, Castelli W P, Werter J. The prognostic significance of proteinuria: the Framingham study. Am Heart J . 1984; 102 1347-1352
- 38 Yudkin J S, Forrest R D, Jackson C A. Microalbuminuria as predictor of vascular disease in nondiabetic subjects. Lancet . 1988; 3 530-533
- 39 Marre M. Microalbuminuria and prevention of renal insufficiency and cardiovascular diseases. Am J Hypertens . 1998; 11 884-886
- 40 Marre M, Bouhanick B, Berrut G. Microalbuminuria. Curr Opin Nephrol Hypertens . 1994; 3 558-556
- 41 Deckert T, Feldt-Rasmussen B, Borch-Johnsen K, Jensen T, Kofoed-Enevoldsen A. Albuminuria reflects widespread vascular damage: the Steno hypothesis. Diabetologia . 1989; 32 219-226
- 42 Hostetter T H, Troy J L, Brenner B M. Glomerular hemodynamics in experimental diabetes mellitus. Kidney Int . 1981; 19 410-415
- 43 Scholey J W, Meyer T W. Control of glomerular hypertension by insulin administration in diabetic rats. J Clin Invest . 1989; 83 1384-1389
- 44 Zatz R, Meyer T W, Rennke H G, Brenner B M. Predominance of hemodynamic rather than metabolic factors in the pathogenesis of diabetic glomerulopathy. Proc Natl Acad Sci USA . 1985; 82 5963-5967
- 45 Zatz R, Dunn B R, Meyer T W, Anderson S, Rennke H G, Brenner B M. Prevention of diabetic glomerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest . 1986; 77 1925-1930
- 46 Anderson S, Rennke H G, Garcia D L, Brenner B M. Short- and long-term effects of antihypertensive therapy in the diabetic rat. Kidney Int . 1989; 36 526-536
- 47 Nishikawa T, Edelstein D, Liang D u. Normalizing mitochondrial superoxide production blocks three pathways of hyperglycaemic damage. Nature . 2000; 404 787-790
- 48 Starling E H. Physiological factors involved in the causation of dropsy. Lancet . 1886; 1 1405-1458
- 49 Ito S, Arima S, Ren Y L, Juncos L A, Carretero O A. Endothelium-derived factor/nitric oxide modulates angiotensin II action in the isolated microperfused rabbit afferent but not efferent arteriole. J Clin Invest . 1993; 91 2012-2019
- 50 Marre M, Leblanc H, Suarez L, Guyenne T T, Menard J, Passa P. Converting enzyme inhibition and kidney function in normotensive diabetic patients with persistent microalbuminuria. BMJ . 1987; 294 1448-1452
- 51 Shankland S J, Ly H, Thai K, Scholey J W. Increased glomerular capillary pressure alters glomerular cytokine expression. Circ Res . 1994; 75 844-853
- 52 Sharma K, Ziyadeh F N. Hyperglycemia and diabetic kidney disease. The case for transforming growth factor-β as a key mediator. Diabetes . 1995; 44 1139-1146
- 53 Rocco M V, Chen Y, Goldfarb S, Ziyadeh F N. Elevated glucose stimulates TGF-β gene expression and bioactivity in proximal tubules. Kidney Int . 1992; 41 107-114
- 54 Gilbert R E, Cox A, Wu L L. Expression of transforming growth factor β1 and type IV collagen in the renal tubulointerstitium in experimental diabetes: effects of angiotensin converting enzyme inhibition. Diabetes . 1998; 47 414-422
- 55 Chen S, Iglesias de la Cruz C, Isono M, Ziyadeh F N. Transforming growth factor-β and other cytokines in experimental and human nephropathy. In: Mogensen CE, ed. The Kidney and Hypertension in Diabetes Mellitus. Boston, MA: Kluwer Academic Pub 2000: 313-338
- 56 Feldt-Rasmussen B, Mathiesen E, Deckert T. Central role for sodium in the pathogenesis of blood pressure changes independent of angiotensin, aldosterone and catecholamines in type 1 (insulin-dependent) diabetes mellitus. Diabetologia . 1987; 30 610-617
- 57 Danser A HJ, van den Dorpel A N, Deinum J. Renin, prorenin and immunoreactive renin in vitreous fluid from eyes with and without diabetic retinopathy. J Clin Endocrinol Metab . 1989; 68 160-167
- 58 Jones S, Nyengaard J S. Birth, Barker and Brenner: the concept of low birth weight and renal disease. In: Mogensen, CE, ed. The Kidney and Hypertension in Diabetes Mellitus. 5th ed. Boston, MA: Kluwer Academic Publ 2000: 129-139
- 59 Hinchliffe S A, Lynch M R, Sargent P H, Howard C V, van Velzn D. The effect of intrauterine growth retardation on the development of renal nephrons. Br J Obstet Gynaecol . 1992; 99 296-301
- 60 Kasiske B L, O'Donnell M P, Schmitz P G, Kim Y, Keane W F. Renal injury of diet-induced hypercholesterolemia in rats. Kidney Int . 1990; 37 880-891
- 61 Jensen T. Increased plasma level of von Willebrand factor in type 1 (insulin-dependent) diabetic patients with incipient nephropathy. BMJ . 1989; 298 27-28
- 62 Yip J, Mattock M, Sethi M, Moroccuti A, Viberti G C. Insulin resistance in family members of insulin-dependent diabetic patients with microalbuminuria [letter]. Lancet . 1993; 341 369-370
- 63 Sharma A M, Jeunemaitre X. The future of genetic association studies in hypertension: improving the signal-to-noise ratio. J Hypertens . 2000; 18 811-814
- 64 Marre M. Genetics and the prediction of complications in type 1 diabetes. Diabetes Care . 1999; 22 B53-B58
- 65 Ko B CB, Lam K SL, Wat N MS, Chung S SM. An (A-C)n dinucleotide repeat polymorphic marker at the 5′ end of the aldose reductase gene is associated with early-onset diabetic retinopathy in NIDDM patients. Diabetes . 1995; 44 727-732
- 66 Heesom A E, Hibberd M L, Millward A, Demaine A G. Polymorphism in the 5′ end of the aldose reductase gene is strongly associated with the development of diabetic nephropathy in type I diabetes. Diabetes . 1997; 46 287-291
- 67 Poirier O, Nicaud V, Vionnet N. Polymorphism screening of four genes encoding advanced glycation end product putative receptors: association study with nephropathy in type 1 diabetic patients. Diabetes . 2001; 50 1214-1218
- 68 Pociot F, Hansen P M, Karlsen A E, Langdahl B L, Johannesen J, Nerup J. TGF-beta-1 gene mutations in insulin-dependent diabetes mellitus and diabetic nephropathy. J Am Soc Nephrol . 1998; 9 2302-2307
- 69 Fogarty D G, Harron J C, Hughes A E, Nevin N C, Doherty C C, Maxwell A P. A molecular variant of angiotensinogen is associated with diabetic nephropathy in IDDM. Diabetes . 1996; 45 1204-1208
- 70 Marre M, Jeunemaitre X, Gallois Y. Contribution of genetic polymorphism in the renin-angiotensin system to the development of renal complications in insulin-dependent diabetes. J Clin Invest . 1997; 99 1585-1595
- 71 Doria A, Onuma T, Warram J H, Krolewski A S. Synergistic effect of angiotensin II type 1 receptor genotype and poor glycaemic control on risk of nephropathy in IDDM. Diabetologia . 1997; 40 1293-1299
- 72 Miller J A, Thai K, Sholey J W. Angiotensin II type 1 receptor gene polymorphism and the response to hyperglycemia in early type 1 diabetes. Diabetes . 2000; 49 1585-1589
- 73 Staessen J A, Wang J G, Ginocchio G. The deletion/insertion polymorphism of the angiotensin converting enzyme gene and cardiovascular renal risk. J Hypertens . 1997; 15 1579-1592
- 74 Fujisawa T, Ikegami H, Kawaguchi Y. Meta-analysis of association of insertion/deletion polymorphism of angiotensin I converting enzyme gene with diabetic nephropathy and retinopathy. Diabetologia . 1998; 41 47-53
- 75 Rigat B, Hubert C, Alhenc-Gelas F, Cambien F, Corvol P, Soubrier F. An insertion/deletion polymorphism in angiotensin I conversion enzyme gene accounting for half of the variance of serum enzyme levels. J Clin Invest . 1990; 86 1343-1346
- 76 Alhenc-Gelas F, Baussant T, Hubert C, Soubrier F, Corvol P. The angiotensin I converting enzyme in the kidney. J Hypertens . 1989; 7 S9-S13
- 77 Marre M, Bernadet P, Gallois Y. Relationships between angiotensin I converting enzyme gene polymorphism, plasma levels, and diabetic retinal and renal complications. Diabetes . 1994; 43 384-388
- 78 Hadjadj S, Belloum R, Bouhanick B. Prognostic value of angiotensin-I converting enzyme D/I polymorphism for nephropathy in type 1 diabetes: a prospective study. J Am Soc Nephrol . 2001; 12 541-549
- 79 Marre M, Bouhanick B, Berrut G. Renal changes on hyperglycemia and angiotensin-converting enzyme in type 1 diabetes. Hypertension . 1999; 33 775-780
- 80 Rudberg S, Bangstad H J, Rasmussen L M, Østerby R. Influence of insertion/deletion polymorphism in the ACE-I gene on the progression of diabetic glomerulopathy in type 1 diabetic patients with microalbuminuria. Diabetes Care . 2000; 23 544-548
- 81 Pirart J. Diabète et complications dégénératives. Présentation d'une étude prospective portant sur 4400 cas observés entre 1947 et 1973. Diabete Metab . 1977; 3 97-256
- 82 Mauer S, Steffes M W, Sutherland D ER, Najarian J S, Michael A F, Brown D M. Studies of the rate of regression of the glomerular lesions in diabetic rats treated with pancreatic islet transplantation. Diabetes . 1975; 24 250-255
- 83 The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med . 1993; 329 977-986
- 84 Feldt-Rasmussen B, Mathiesen E R, Deckert T. Effect of two years of strict metabolic control on progression of incipient nephropathy in insulin-dependent diabetes. Lancet . 1986; 2 1300-1304
- 85 Microalbuminuria Collaborative Study Group, United Kingdom. Intensive therapy and progression to clinical albuminuria in patients with insulin-dependent diabetes mellitus and microalbuminuria. BMJ . 1995; 311 973-977
- 86 Viberti G C, Bilous R W, Makintosh D, Bending J J, Keen H. Long-term correction of hyperglycaemia and progression of renal failure in insulin-dependent diabetes. BMJ . 1983; 286 598-602
- 87 Daniels B S, Hostetter T H. Aldose reductase inhibition and glomerular abnormalities in diabetic rats. Diabetes . 1989; 38 981-986
- 88 Soulis-Liparoth T, Cooper M, Papazoglou D, Clarke B, Jerums G R. Retardation by aminoguanidine of development of albuminuria, mesangial expansion, and tissue fluorescence in streptozotocin-induced diabetic rat. Diabetes . 1991; 40 1328-1334
- 89 Walker J D, Bending J J, Dodds R A. Restriction of dietary protein and progression of renal failure in diabetic nephropathy. Lancet . 1989; 2 1411-1415
- 90 Klahr S, Levey A S, Beck G J. The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease. N Engl J Med . 1994; 330 877-884
- 91 Taguma Y, Kitamoto Y, Futaki G. Effect of captopril on heavy proteinuria in azotemic diabetics. N Engl J Med . 1985; 313 1617-1620
- 92 Marre M, Chatellier G, Leblanc H. Prevention of diabetic nephropathy with enalapril in normotensive diabetics with microalbuminuria. BMJ . 1988; 297 1092-1095
- 93 Hallab M, Gallois Y, Chatellier G, Rohmer V, Fressinaud P h, Marre M. Comparison of reduction in microalbuminuria by enalapril and hydrochlorothiazide in normotensive patients with insulin dependent diabetes. BMJ . 1993; 306 175-182
- 94 The ACE Inhibitors in Diabetic Nephropathy Trialist Group. Should all type 1 diabetic patients with microalbuminuria receive ACE inhibitors?. <~>A meta-regression analysis. Ann Intern Med . 2001; 134 370-379
- 95 Mogensen C E, Keane W F, Bennett P H. Prevention of diabetic renal disease with special reference to microalbuminuria. Lancet . 1995; 346 1080-1084
- 96 Lewis E J, Hunsiker L G, Bain R P, Rohde R D, for the Collaborative Study Group. The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. N Engl J Med . 1993; 329 1456-1462
- 97 Björck S, Mulec H, Johnsen S A, Nyberg G, Aurell M. Renal protective effect of enalapril in diabetic nephropathy. BMJ . 1992; 304 339-343
- 98 The Euclid Study Group. Randomized placebo-controlled trial of lisinopril in normotensive patients with insulin-dependent diabetes and normoalbuminuria or microalbuminuria. Lancet . 1997; 349 1787-1792
- 99 Mimram A, Insua A, Ribstein J, Bringer J, Monnier L. Comparative effects of captopril and nifedipine in normotensive patients with incipient diabetic nephropathy. Diabetes Care . 1988; 11 850-853
- 100 Crepaldi G, Carta Q, Deferrari G, and The Italian Microalbuminuria Study Group in IDDM. Effects of lisinopril and nifedipine on the progression to overt albuminuria in IDDM patients with incipient nephropathy and normal blood pressure. Diabetes Care . 1998; 21 104-110
- 101 Parving H H, Andersen A H, Shmidt U, Hommel E, Mathiesen E R, Svendsen P A. Antihypertensive treatment postpones end stage renal failure in diabetic nephropathy. BMJ . 1987; 294 1443-1447