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Books > Medicine > Clinical & internal medicine > Endocrinology > Diabetes
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The Kidney and Hypertension in Diabetes Mellitus (Paperback, 2nd ed. 1994. Softcover reprint of the original 2nd ed. 1994)
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The Kidney and Hypertension in Diabetes Mellitus (Paperback, 2nd ed. 1994. Softcover reprint of the original 2nd ed. 1994)
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The sum of clinical problems caused by diabetic renal disease has
been steadily increasing since the first edition of this book was
published in 1988. The years since have seen tremendous progress in
research activities. Importantly, this also includes improvement in
the treatment programs to prevent end-stage renal failure. It has
become clear that the diabetic kidney is extremely
pressure-sensitive, responding to effective antihypertensive
treatment by retarded progression of disease. Some agents may be
more beneficial in this respect than others, although effective
blood pressure reduction per se is crucial throughout the stages of
diabetic renal disease. However, the prime cause of diabetic renal
disease is related to poor metabolic control and it is now
documented beyond doubt that good metabolic control is able to
postpone or perhaps even prevent the development of renal disease.
However, in many individuals we are not able to provide such a
quality of control that will prevent complications, and therefore
non-glycaemic intervention remains important.Maybe in the future
non-glycaemic intervention will become the most important research
area in diabetic nephropathy. Much information is now available on
the exact mechanisms behind poor metabolic control and development
of renal disease. It is likely that a combination of genetic
predisposition and metabolic and haemodynamic abnormalities explain
the progression to renal disease, seen in about 30% of diabetic
individuals. Much of this development probably relates to
modifiable genetic factors, such as blood pressure elevation or
haemodynamic aberrations. However, mechanisms related to the
response to hyperglycaemia are also of clear importance, as is the
possibility that these metabolic or haemodynamic pathways may be
inhibited. This volume reviews older data as well as the progress
seen within the research on diabetic nephropathy over the last five
years and describes the state of the art of the development.
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