Abstract :
The clinical disorder of diabetes mellitus provides an excellent example of the application of basic physiological principles to the amelioration of a common and dire microvascular complication, namely diabetic glomerulopathy. This nephropathy occurs in some 30-50% of patients with Type I and Type II forms of diabetes and eventuates in end-stage renal disease. Of interest, supernormal GFR (hyperfiltration) precedes and is a powerful predictor of this complication. Animal studies reveal hyperfiltration to be the consequence of glomerular hypertension, a potential cause of subsequent glomerular injury. Placement of diabetic rats with glomerular hypertension and hyperfiltration on low protein diets, or ACE inhibitors, treatments that return elevated glomerular pressures to normal, abrogate the expected glomerular injury. Numerous clinical trials in Type I and II patients confirm the reno-protective effect of both approaches, offering the hope that, with initiation of early treatment, this dreaded nephropathy complication can be avoided.
