The earliest manifestations of clinical diabetic nephropathy, including proteinuria, hypertension, and declining GFR, represent very advanced diabetic glomerulopathy with especially prominent mesangial expansion. Mesangial expansion, by restricting glomerular capillary filtration surface and lumenal volume, stimulates compensatory mechanisms analogous to those resulting from a marked reduction in nephron number. These compensatory mechanisms involve alterations in glomerular hemodynamics designed to maintain glomerular filtration but which ultimately injure the kidney. These hemodynamic perturbations are not specific to diabetes but represent a final common pathway toward endstage renal failure that also characterizes the remnant kidney. This thesis concludes that the onset of clinical diabetic nephropathy augurs inevitable decline in kidney function, and that only studies and interventions exercised before clinical nephropathy develops can influence understanding and outcome of diabetic nephropathy.
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June 01 1983
Diabetic Nephropathy: A Perspective
S Michael Mauer;
S Michael Mauer
Departments of Pediatrics, Internal Medicine, Surgery, and Laboratory Medicine and Pathology, University of Minnesota School of Medicine
Minneapolis, Minnesota
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Michael W Steffes;
Michael W Steffes
Departments of Pediatrics, Internal Medicine, Surgery, and Laboratory Medicine and Pathology, University of Minnesota School of Medicine
Minneapolis, Minnesota
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Frederick C Goetz;
Frederick C Goetz
Departments of Pediatrics, Internal Medicine, Surgery, and Laboratory Medicine and Pathology, University of Minnesota School of Medicine
Minneapolis, Minnesota
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David E R Sutherland;
David E R Sutherland
Departments of Pediatrics, Internal Medicine, Surgery, and Laboratory Medicine and Pathology, University of Minnesota School of Medicine
Minneapolis, Minnesota
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David M Brown
David M Brown
Departments of Pediatrics, Internal Medicine, Surgery, and Laboratory Medicine and Pathology, University of Minnesota School of Medicine
Minneapolis, Minnesota
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Address reprint requests to S. Michael Mauer, M.D., Department of Pediatrics, University of Minnesota, Box 491 May Building, 420 Delaware Street S.E., Minneapolis, Minnesota 55455
Diabetes 1983;32(Supplement_2):52–55
Citation
S Michael Mauer, Michael W Steffes, Frederick C Goetz, David E R Sutherland, David M Brown; Diabetic Nephropathy: A Perspective. Diabetes 1 June 1983; 32 (Supplement_2): 52–55. https://doi.org/10.2337/diab.32.2.S52
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