14th July 2024

Background

Diabetes is the commonest cause of chronic kidney disease (CKD) and end stage renal failure (ESRF) in the world with diabetic nephropathy increasing both morbidity and mortality in diabetic patients. Peak incidence of nephropathy is between 10 and 20 years after diagnosis and patients with type 1 diabetes are more likely to follow a predictable decline toward ESRF than type 2 diabetes; perhaps due to higher mortality associated with cardiovascular events in type 2 patients.

Multiple mechanisms are involved in the development of diabetic nephropathy. These include persistent hyperglycaemia, increased oxidative stress and initial hyperfiltration leading to micro-endovascular damage and glomerular sclerosis.  The development of secondary hypertension further worsens the picture.