Robert H. Noth, MD; Andrzej S. Krolewski, MD, PhD; George A. Kaysen, MD, PhD; Timothy W. Meyer, MD; Morris Schambelan, MD
New evidence shows that systemic and intrarenal hemodynamic abnormalities are major factors in the initiation and progression of diabetic nephropathy. Genetic predisposition to elevated systemic blood pressure may contribute to its development. Glomerular vasodilation and hyperfiltration, mediated in part by prostaglandins, may play a role in glomerular damage early in the course of diabetes, but clinical studies are limited. The development of more sensitive assays for albuminuria now allows early diagnosis of incipient nephropathy in the "microalbuminuria" phase. Treatment during this phase with antihypertensive agents, including angiotensin-converting enzyme inhibitors, or with dietary protein restriction, can decrease the degree of albuminuria,
Noth RH, Krolewski AS, Kaysen GA, Meyer TW, Schambelan M. Diabetic Nephropathy: Hemodynamic Basis and Implications for Disease Management. Ann Intern Med. ;110:795–813. doi: 10.7326/0003-4819-110-10-795
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Published: Ann Intern Med. 1989;110(10):795-813.
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