Acquired oligonephropathy and diabetic nephropathy.
Congenital or acquired nephron number reduction and diabetes mellitus both induce hyperfiltration and intrarenal hypertension. These hemodynamic factors have been suggested to play an important role in the initiation and progression of diabetic and nondiabetic glomerulopathies. In a prevalence cohort of all 50 albuminuric (> or = 300 mg/24 hr), non-insulin-dependent diabetic mellitus (NIDDM) patients (aged < 66 years) attending a diabetic clinic during 1987, we identified four patients with acquired oligonephropathy who had developed diabetic nephropathy. Three patients only had a single functioning kidney (nephrectomy in two cases), and the remaining patient had unilateral severely reduced kidney function and elevated plasma renin concentration. These patients represent 8% of our NIDDM population with albuminuria, and are the only patients in our NIDDM population younger than 66 years (n = 363) known to have single kidneys. However, systematic renography screening was not performed. During the observation period, which ranged from 16 to 100 months, albuminuria increased from 2.3 g/24 hr (range, 1.2 to 3.4 g/24 hr) to 3.2 g/24 hr (range, 0.7 to 9.4 g/24 hr), glomerular filtration rate decreased to 6 mL/min/yr (range, 4 to 12 mL/min/yr), and blood pressure remained stable at 142/92 mm Hg. Three patients received antihypertensive medication. Two of the patients died after 16 and 26 months of observation, respectively, due to acute myocardial infarction and stroke. The results of our study of NIDDM patients support the concept that reduced nephron number predispose patients to the development of diabetic nephropathy.
Nielsen
F S
FS
Steno Diabetes Center, Gentofte, Denmark.
Gall
M A
MA
Parving
H H
HH
D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003928:Diabetic Nephropathies / Q000209:etiology*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D009399:Nephrons / Q000473:pathology*