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. 2004 Nov;80(949):624–633. doi: 10.1136/pgmj.2004.021287

Recent advances in diabetic nephropathy

S Marshall 1
PMCID: PMC1743135  PMID: 15537844

Abstract

Diabetic nephropathy is the leading cause of end stage renal disease worldwide and is associated with increased cardiovascular risk. The earliest clinical manifestation is of microalbuminuria. Tight blood glucose and blood pressure control reduce the risk of microalbuminuria. Once microalbuminuria is present, the rate of progression to end stage renal disease and of cardiovascular disease can be delayed by aggressive management of blood pressure, glucose, and lipids. Inhibition of the renin-angiotensin system is important to reduce intraglomerular pressure but other classes of antihypertensive agent may also be needed to gain adequate control of systemic blood pressure. Such measures can at least half the rate of progression of nephropathy and cardiovascular disease.

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Selected References

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  1. Adedapo K. S., Abbiyesuku F. M., Adedapo A. D., Osotimehin B. O. Microalbuminuria in controlled type 2 diabetes mellitus patients. Afr J Med Med Sci. 2001 Dec;30(4):323–326. [PubMed] [Google Scholar]
  2. Adler A. I., Stratton I. M., Neil H. A., Yudkin J. S., Matthews D. R., Cull C. A., Wright A. D., Turner R. C., Holman R. R. Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study. BMJ. 2000 Aug 12;321(7258):412–419. doi: 10.1136/bmj.321.7258.412. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Adler Amanda I., Stevens Richard J., Manley Sue E., Bilous Rudy W., Cull Carole A., Holman Rury R., UKPDS GROUP Development and progression of nephropathy in type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS 64). Kidney Int. 2003 Jan;63(1):225–232. doi: 10.1046/j.1523-1755.2003.00712.x. [DOI] [PubMed] [Google Scholar]
  4. Andersen A. R., Christiansen J. S., Andersen J. K., Kreiner S., Deckert T. Diabetic nephropathy in Type 1 (insulin-dependent) diabetes: an epidemiological study. Diabetologia. 1983 Dec;25(6):496–501. doi: 10.1007/BF00284458. [DOI] [PubMed] [Google Scholar]
  5. Arun Chankramath S., Stoddart James, Mackin Paul, MacLeod Jean M., New John P., Marshall Sally M. Significance of microalbuminuria in long-duration type 1 diabetes. Diabetes Care. 2003 Jul;26(7):2144–2149. doi: 10.2337/diacare.26.7.2144. [DOI] [PubMed] [Google Scholar]
  6. 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 Jan 6;330(1):15–18. doi: 10.1056/NEJM199401063300103. [DOI] [PubMed] [Google Scholar]
  7. Borch-Johnsen K., Andersen P. K., Deckert T. The effect of proteinuria on relative mortality in type 1 (insulin-dependent) diabetes mellitus. Diabetologia. 1985 Aug;28(8):590–596. doi: 10.1007/BF00281993. [DOI] [PubMed] [Google Scholar]
  8. Borch-Johnsen K., Kreiner S. Proteinuria: value as predictor of cardiovascular mortality in insulin dependent diabetes mellitus. Br Med J (Clin Res Ed) 1987 Jun 27;294(6588):1651–1654. doi: 10.1136/bmj.294.6588.1651. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Brenner B. M., Cooper M. E., de Zeeuw D., Keane W. F., Mitch W. E., Parving H. H., Remuzzi G., Snapinn S. M., Zhang Z., Shahinfar S. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med. 2001 Sep 20;345(12):861–869. doi: 10.1056/NEJMoa011161. [DOI] [PubMed] [Google Scholar]
  10. Brownlee M. Biochemistry and molecular cell biology of diabetic complications. Nature. 2001 Dec 13;414(6865):813–820. doi: 10.1038/414813a. [DOI] [PubMed] [Google Scholar]
  11. Busuttil R. W., Brin B. J. The diagnosis and management of visceral artery aneurysms. Surgery. 1980 Nov;88(5):619–624. [PubMed] [Google Scholar]
  12. Collins V. R., Dowse G. K., Finch C. F., Zimmet P. Z., Linnane A. W. Prevalence and risk factors for micro- and macroalbuminuria in diabetic subjects and entire population of Nauru. Diabetes. 1989 Dec;38(12):1602–1610. doi: 10.2337/diab.38.12.1602. [DOI] [PubMed] [Google Scholar]
  13. Dasmahapatra A., Bale A., Raghuwanshi M. P., Reddi A., Byrne W., Suarez S., Nash F., Varagiannis E., Skurnick J. H. Incipient and overt diabetic nephropathy in African Americans with NIDDM. Diabetes Care. 1994 Apr;17(4):297–304. doi: 10.2337/diacare.17.4.297. [DOI] [PubMed] [Google Scholar]
  14. Deckert T., Yokoyama H., Mathiesen E., Rønn B., Jensen T., Feldt-Rasmussen B., Borch-Johnsen K., Jensen J. S. Cohort study of predictive value of urinary albumin excretion for atherosclerotic vascular disease in patients with insulin dependent diabetes. BMJ. 1996 Apr 6;312(7035):871–874. doi: 10.1136/bmj.312.7035.871. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Dikow Ralf, Ritz Eberhard. Cardiovascular complications in the diabetic patient with renal disease: an update in 2003. Nephrol Dial Transplant. 2003 Oct;18(10):1993–1998. doi: 10.1093/ndt/gfg253. [DOI] [PubMed] [Google Scholar]
  16. Dinneen S. F., Gerstein H. C. The association of microalbuminuria and mortality in non-insulin-dependent diabetes mellitus. A systematic overview of the literature. Arch Intern Med. 1997 Jul 14;157(13):1413–1418. [PubMed] [Google Scholar]
  17. Earle K., Walker J., Hill C., Viberti G. Familial clustering of cardiovascular disease in patients with insulin-dependent diabetes and nephropathy. N Engl J Med. 1992 Mar 5;326(10):673–677. doi: 10.1056/NEJM199203053261005. [DOI] [PubMed] [Google Scholar]
  18. Fogarty D. G., Rich S. S., Hanna L., Warram J. H., Krolewski A. S. Urinary albumin excretion in families with type 2 diabetes is heritable and genetically correlated to blood pressure. Kidney Int. 2000 Jan;57(1):250–257. doi: 10.1046/j.1523-1755.2000.00833.x. [DOI] [PubMed] [Google Scholar]
  19. Forsblom C. M., Groop P. H., Ekstrand A., Groop L. C. Predictive value of microalbuminuria in patients with insulin-dependent diabetes of long duration. BMJ. 1992 Oct 31;305(6861):1051–1053. doi: 10.1136/bmj.305.6861.1051. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Fuller J. H., Stevens L. K., Wang S. L. Risk factors for cardiovascular mortality and morbidity: the WHO Mutinational Study of Vascular Disease in Diabetes. Diabetologia. 2001 Sep;44 (Suppl 2):S54–S64. doi: 10.1007/pl00002940. [DOI] [PubMed] [Google Scholar]
  21. Gaede Peter, Vedel Pernille, Larsen Nicolai, Jensen Gunnar V. H., Parving Hans-Henrik, Pedersen Oluf. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med. 2003 Jan 30;348(5):383–393. doi: 10.1056/NEJMoa021778. [DOI] [PubMed] [Google Scholar]
  22. Gaede Peter, Vedel Pernille, Larsen Nicolai, Jensen Gunnar V. H., Parving Hans-Henrik, Pedersen Oluf. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med. 2003 Jan 30;348(5):383–393. doi: 10.1056/NEJMoa021778. [DOI] [PubMed] [Google Scholar]
  23. Gall M. A., Hougaard P., Borch-Johnsen K., Parving H. H. Risk factors for development of incipient and overt diabetic nephropathy in patients with non-insulin dependent diabetes mellitus: prospective, observational study. BMJ. 1997 Mar 15;314(7083):783–788. doi: 10.1136/bmj.314.7083.783. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Gilbert R. E., Cooper M. E. The tubulointerstitium in progressive diabetic kidney disease: more than an aftermath of glomerular injury? Kidney Int. 1999 Nov;56(5):1627–1637. doi: 10.1046/j.1523-1755.1999.00721.x. [DOI] [PubMed] [Google Scholar]
  25. Gill G. V., Woodward A., Pradhan S., Wallymahmed M., Groves T., English P., Wilding J. P. Intensified treatment of type 2 diabetes--positive effects on blood pressure, but not glycaemic control. QJM. 2003 Nov;96(11):833–836. doi: 10.1093/qjmed/hcg143. [DOI] [PubMed] [Google Scholar]
  26. Gruden G., Zonca S., Hayward A., Thomas S., Maestrini S., Gnudi L., Viberti G. C. Mechanical stretch-induced fibronectin and transforming growth factor-beta1 production in human mesangial cells is p38 mitogen-activated protein kinase-dependent. Diabetes. 2000 Apr;49(4):655–661. doi: 10.2337/diabetes.49.4.655. [DOI] [PubMed] [Google Scholar]
  27. Hansen Henrik Post, Tauber-Lassen Ellis, Jensen Berit R., Parving Hans-Henrik. Effect of dietary protein restriction on prognosis in patients with diabetic nephropathy. Kidney Int. 2002 Jul;62(1):220–228. doi: 10.1046/j.1523-1755.2002.00421.x. [DOI] [PubMed] [Google Scholar]
  28. Harvey J. N., Rizvi K., Craney L., Messenger J., Shah R., Meadows P. A. Population-based survey and analysis of trends in the prevalence of diabetic nephropathy in Type 1 diabetes. Diabet Med. 2001 Dec;18(12):998–1002. doi: 10.1046/j.1464-5491.2001.00630.x. [DOI] [PubMed] [Google Scholar]
  29. Hovind P., Rossing P., Tarnow L., Smidt U. M., Parving H. H. Remission and regression in the nephropathy of type 1 diabetes when blood pressure is controlled aggressively. Kidney Int. 2001 Jul;60(1):277–283. doi: 10.1046/j.1523-1755.2001.00797.x. [DOI] [PubMed] [Google Scholar]
  30. Hovind P., Rossing P., Tarnow L., Toft H., Parving J., Parving H. H. Remission of nephrotic-range albuminuria in type 1 diabetic patients. Diabetes Care. 2001 Nov;24(11):1972–1977. doi: 10.2337/diacare.24.11.1972. [DOI] [PubMed] [Google Scholar]
  31. Hovind Peter, Tarnow Lise, Rossing Kasper, Rossing Peter, Eising Stefanie, Larsen Nicolai, Binder Christian, Parving Hans-Henrik. Decreasing incidence of severe diabetic microangiopathy in type 1 diabetes. Diabetes Care. 2003 Apr;26(4):1258–1264. doi: 10.2337/diacare.26.4.1258. [DOI] [PubMed] [Google Scholar]
  32. Jacobsen Peter, Andersen Steen, Jensen Berit R., Parving Hans-Henrik. Additive effect of ACE inhibition and angiotensin II receptor blockade in type I diabetic patients with diabetic nephropathy. J Am Soc Nephrol. 2003 Apr;14(4):992–999. doi: 10.1097/01.asn.0000054495.96193.bf. [DOI] [PubMed] [Google Scholar]
  33. Jacobsen Peter, Andersen Steen, Rossing Kasper, Jensen Berit R., Parving Hans-Henrik. Dual blockade of the renin-angiotensin system versus maximal recommended dose of ACE inhibition in diabetic nephropathy. Kidney Int. 2003 May;63(5):1874–1880. doi: 10.1046/j.1523-1755.2003.00940.x. [DOI] [PubMed] [Google Scholar]
  34. John L., Rao P. S., Kanagasabapathy A. S. Rate of progression of albuminuria in type II diabetes. Five-year prospective study from south India. Diabetes Care. 1994 Aug;17(8):888–890. doi: 10.2337/diacare.17.8.888. [DOI] [PubMed] [Google Scholar]
  35. Kim D. J., Kim Y. M., Yun Y. S., Ahn C. W., Cha B. S., Song Y. D., Lim S. K., Kim K. R., Hahn J. S., Huh K. B. Therapeutic effect of recombinant human erythropoietin on anaemia with erythropoietin deficiency in diabetic patients. Diabet Med. 2003 Aug;20(8):661–664. doi: 10.1046/j.1464-5491.2003.01012.x. [DOI] [PubMed] [Google Scholar]
  36. Kofoed-Enevoldsen A., Borch-Johnsen K., Kreiner S., Nerup J., Deckert T. Declining incidence of persistent proteinuria in type I (insulin-dependent) diabetic patients in Denmark. Diabetes. 1987 Feb;36(2):205–209. doi: 10.2337/diab.36.2.205. [DOI] [PubMed] [Google Scholar]
  37. Lacourcière Y., Bélanger A., Godin C., Hallé J. P., Ross S., Wright N., Marion J. Long-term comparison of losartan and enalapril on kidney function in hypertensive type 2 diabetics with early nephropathy. Kidney Int. 2000 Aug;58(2):762–769. doi: 10.1046/j.1523-1755.2000.00224.x. [DOI] [PubMed] [Google Scholar]
  38. Langham R. G., Kelly D. J., Cox A. J., Thomson N. M., Holthöfer H., Zaoui P., Pinel N., Cordonnier D. J., Gilbert R. E. Proteinuria and the expression of the podocyte slit diaphragm protein, nephrin, in diabetic nephropathy: effects of angiotensin converting enzyme inhibition. Diabetologia. 2002 Sep 25;45(11):1572–1576. doi: 10.1007/s00125-002-0946-y. [DOI] [PubMed] [Google Scholar]
  39. Lewis E. J., Hunsicker L. G., Bain R. P., Rohde R. D. The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. The Collaborative Study Group. N Engl J Med. 1993 Nov 11;329(20):1456–1462. doi: 10.1056/NEJM199311113292004. [DOI] [PubMed] [Google Scholar]
  40. Lewis E. J., Hunsicker L. G., Clarke W. R., Berl T., Pohl M. A., Lewis J. B., Ritz E., Atkins R. C., Rohde R., Raz I. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med. 2001 Sep 20;345(12):851–860. doi: 10.1056/NEJMoa011303. [DOI] [PubMed] [Google Scholar]
  41. Majeski J. Splenic artery tortuosity simulating a splenic artery aneurysm. South Med J. 1998 Oct;91(10):949–951. doi: 10.1097/00007611-199810000-00010. [DOI] [PubMed] [Google Scholar]
  42. Microvascular and acute complications in IDDM patients: the EURODIAB IDDM Complications Study. Diabetologia. 1994 Mar;37(3):278–285. doi: 10.1007/BF00398055. [DOI] [PubMed] [Google Scholar]
  43. Mogensen C. E., Neldam S., Tikkanen I., Oren S., Viskoper R., Watts R. W., Cooper M. E. Randomised controlled trial of dual blockade of renin-angiotensin system in patients with hypertension, microalbuminuria, and non-insulin dependent diabetes: the candesartan and lisinopril microalbuminuria (CALM) study. BMJ. 2000 Dec 9;321(7274):1440–1444. doi: 10.1136/bmj.321.7274.1440. [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Mogensen C. E., Neldam S., Tikkanen I., Oren S., Viskoper R., Watts R. W., Cooper M. E. Randomised controlled trial of dual blockade of renin-angiotensin system in patients with hypertension, microalbuminuria, and non-insulin dependent diabetes: the candesartan and lisinopril microalbuminuria (CALM) study. BMJ. 2000 Dec 9;321(7274):1440–1444. doi: 10.1136/bmj.321.7274.1440. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Mussap Michele, Dalla Vestra Michele, Fioretto Paola, Saller Alois, Varagnolo Mariacristina, Nosadini Romano, Plebani Mario. Cystatin C is a more sensitive marker than creatinine for the estimation of GFR in type 2 diabetic patients. Kidney Int. 2002 Apr;61(4):1453–1461. doi: 10.1046/j.1523-1755.2002.00253.x. [DOI] [PubMed] [Google Scholar]
  46. Nelson R. G., Meyer T. W., Myers B. D., Bennett P. H. Course of renal disease in Pima Indians with non-insulin-dependent diabetes mellitus. Kidney Int Suppl. 1997 Dec;63:S45–S48. [PubMed] [Google Scholar]
  47. Orchard T. J., Dorman J. S., Maser R. E., Becker D. J., Drash A. L., Ellis D., LaPorte R. E., Kuller L. H. Prevalence of complications in IDDM by sex and duration. Pittsburgh Epidemiology of Diabetes Complications Study II. Diabetes. 1990 Sep;39(9):1116–1124. doi: 10.2337/diab.39.9.1116. [DOI] [PubMed] [Google Scholar]
  48. Osterby R., Parving H. H., Hommel E., Jørgensen H. E., Løkkegaard H. Glomerular structure and function in diabetic nephropathy. Early to advanced stages. Diabetes. 1990 Sep;39(9):1057–1063. doi: 10.2337/diab.39.9.1057. [DOI] [PubMed] [Google Scholar]
  49. Parving H. H., Lehnert H., Bröchner-Mortensen J., Gomis R., Andersen S., Arner P., Irbesartan in Patients with Type 2 Diabetes and Microalbuminuria Study Group The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. N Engl J Med. 2001 Sep 20;345(12):870–878. doi: 10.1056/NEJMoa011489. [DOI] [PubMed] [Google Scholar]
  50. Parving H. H., Lehnert H., Bröchner-Mortensen J., Gomis R., Andersen S., Arner P., Irbesartan in Patients with Type 2 Diabetes and Microalbuminuria Study Group The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. N Engl J Med. 2001 Sep 20;345(12):870–878. doi: 10.1056/NEJMoa011489. [DOI] [PubMed] [Google Scholar]
  51. Pavenstädt Hermann, Kriz Wilhelm, Kretzler Matthias. Cell biology of the glomerular podocyte. Physiol Rev. 2003 Jan;83(1):253–307. doi: 10.1152/physrev.00020.2002. [DOI] [PubMed] [Google Scholar]
  52. Pedrini M. T., Levey A. S., Lau J., Chalmers T. C., Wang P. H. The effect of dietary protein restriction on the progression of diabetic and nondiabetic renal diseases: a meta-analysis. Ann Intern Med. 1996 Apr 1;124(7):627–632. doi: 10.7326/0003-4819-124-7-199604010-00002. [DOI] [PubMed] [Google Scholar]
  53. Perkins Bruce A., Ficociello Linda H., Silva Kristen H., Finkelstein Dianne M., Warram James H., Krolewski Andrzej S. Regression of microalbuminuria in type 1 diabetes. N Engl J Med. 2003 Jun 5;348(23):2285–2293. doi: 10.1056/NEJMoa021835. [DOI] [PubMed] [Google Scholar]
  54. Ravid M., Savin H., Jutrin I., Bental T., Katz B., Lishner M. Long-term stabilizing effect of angiotensin-converting enzyme inhibition on plasma creatinine and on proteinuria in normotensive type II diabetic patients. Ann Intern Med. 1993 Apr 15;118(8):577–581. doi: 10.7326/0003-4819-118-8-199304150-00001. [DOI] [PubMed] [Google Scholar]
  55. Rossing Kasper, Christensen Per K., Jensen Berit R., Parving Hans-Henrik. Dual blockade of the renin-angiotensin system in diabetic nephropathy: a randomized double-blind crossover study. Diabetes Care. 2002 Jan;25(1):95–100. doi: 10.2337/diacare.25.1.95. [DOI] [PubMed] [Google Scholar]
  56. Rossing Kasper, Jacobsen Peter, Pietraszek Lotte, Parving Hans-Henrik. Renoprotective effects of adding angiotensin II receptor blocker to maximal recommended doses of ACE inhibitor in diabetic nephropathy: a randomized double-blind crossover trial. Diabetes Care. 2003 Aug;26(8):2268–2274. doi: 10.2337/diacare.26.8.2268. [DOI] [PubMed] [Google Scholar]
  57. Rossing P., Hougaard P., Borch-Johnsen K., Parving H. H. Predictors of mortality in insulin dependent diabetes: 10 year observational follow up study. BMJ. 1996 Sep 28;313(7060):779–784. doi: 10.1136/bmj.313.7060.779. [DOI] [PMC free article] [PubMed] [Google Scholar]
  58. Ruggenenti Piero, Perna Annalisa, Remuzzi Giuseppe, GISEN Group Investigators Retarding progression of chronic renal disease: the neglected issue of residual proteinuria. Kidney Int. 2003 Jun;63(6):2254–2261. doi: 10.1046/j.1523-1755.2003.00033.x. [DOI] [PubMed] [Google Scholar]
  59. Sano T., Hotta N., Kawamura T., Matsumae H., Chaya S., Sasaki H., Nakayama M., Hara T., Matsuo S., Sakamoto N. Effects of long-term enalapril treatment on persistent microalbuminuria in normotensive type 2 diabetic patients: results of a 4-year, prospective, randomized study. Diabet Med. 1996 Feb;13(2):120–124. doi: 10.1002/(SICI)1096-9136(199602)13:2<120::AID-DIA6>3.0.CO;2-F. [DOI] [PubMed] [Google Scholar]
  60. Sato Atsuhisa, Hayashi Koichi, Naruse Mitsuhide, Saruta Takao. Effectiveness of aldosterone blockade in patients with diabetic nephropathy. Hypertension. 2003 Jan;41(1):64–68. doi: 10.1161/01.hyp.0000044937.95080.e9. [DOI] [PubMed] [Google Scholar]
  61. Sato Atsuhisa, Tabata Mitsuhisa, Hayashi Koichi, Saruta Takao. Effects of the angiotensin II type 1 receptor antagonist candesartan, compared with angiotensin-converting enzyme inhibitors, on the urinary excretion of albumin and type IV collagen in patients with diabetic nephropathy. Clin Exp Nephrol. 2003 Sep;7(3):215–220. doi: 10.1007/s10157-003-0227-1. [DOI] [PubMed] [Google Scholar]
  62. Stratton I. M., Adler A. I., Neil H. A., Matthews D. R., Manley S. E., Cull C. A., Hadden D., Turner R. C., Holman R. R. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000 Aug 12;321(7258):405–412. doi: 10.1136/bmj.321.7258.405. [DOI] [PMC free article] [PubMed] [Google Scholar]
  63. Tan G. D., Lewis A. V., James T. J., Altmann P., Taylor R. P., Levy J. C. Clinical usefulness of cystatin C for the estimation of glomerular filtration rate in type 1 diabetes: reproducibility and accuracy compared with standard measures and iohexol clearance. Diabetes Care. 2002 Nov;25(11):2004–2009. doi: 10.2337/diacare.25.11.2004. [DOI] [PubMed] [Google Scholar]
  64. Tuomilehto J., Borch-Johnsen K., Molarius A., Forsén T., Rastenyte D., Sarti C., Reunanen A. Incidence of cardiovascular disease in Type 1 (insulin-dependent) diabetic subjects with and without diabetic nephropathy in Finland. Diabetologia. 1998 Jul;41(7):784–790. doi: 10.1007/s001250050988. [DOI] [PubMed] [Google Scholar]
  65. Varghese A., Deepa R., Rema M., Mohan V. Prevalence of microalbuminuria in type 2 diabetes mellitus at a diabetes centre in southern India. Postgrad Med J. 2001 Jun;77(908):399–402. doi: 10.1136/pmj.77.908.399. [DOI] [PMC free article] [PubMed] [Google Scholar]
  66. White Kathryn E., Bilous Rudolf W., Marshall Sally M., El Nahas Meguid, Remuzzi Giuseppe, Piras Giampiero, De Cosmo Salvatore, Viberti GianCarlo. Podocyte number in normotensive type 1 diabetic patients with albuminuria. Diabetes. 2002 Oct;51(10):3083–3089. doi: 10.2337/diabetes.51.10.3083. [DOI] [PubMed] [Google Scholar]
  67. Wilkinson Ian B., Mohammad Nadia Haj, Tyrrell Sian, Hall Ian R., Webb David J., Paul Vince E., Levy Terry, Cockcroft John R. Heart rate dependency of pulse pressure amplification and arterial stiffness. Am J Hypertens. 2002 Jan;15(1 Pt 1):24–30. doi: 10.1016/s0895-7061(01)02252-x. [DOI] [PubMed] [Google Scholar]
  68. Yuyun M. F., Dinneen S. F., Edwards O. M., Wood E., Wareham N. J. Absolute level and rate of change of albuminuria over 1 year independently predict mortality and cardiovascular events in patients with diabetic nephropathy. Diabet Med. 2003 Apr;20(4):277–282. doi: 10.1046/j.1464-5491.2003.00940.x. [DOI] [PubMed] [Google Scholar]
  69. 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 Jun;77(6):1925–1930. doi: 10.1172/JCI112521. [DOI] [PMC free article] [PubMed] [Google Scholar]

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