Progression of diabetic nephropathy: A twelve-year follow-up of Type 2 diabetic patients

Abstract

Diabetic nephropathy (DN) is the leading cause of end-stage renal  disease(ESRD) in advanced countries and the third commonest cause of ESRD in Nigeria. Management of diabetic ESRD adds additional economic and morbidity burden for the patient and the nation.The progression of DN can be retarded to delay commencement of renal replacement therapy if hyperglycemia, hypertension and proteinuria are controlled. Twenty-two newly-diagnosed DN patients due to type2 diabetes mellitus(8 males and 14 females)were recruited for the study and followed up for 12 years. Their blood pressure (BP) and fasting blood sugar (FBS)were monitored quarterly at outpatient clinic visit while creatinine clearance (Crcl) and 24hours urine protein excretion (UPE) were assessed annually. Results were  reviewed at the end of study and compared with values at initiation of study. There was significant reduction in  blood pressure (BP) from onsetof study to end of follow-up (p< 0.001). There were significant reductions in systolic blood pressure(SBP), diastolic blood pressure (DBP) and mean arterial pressure (p<0.05). There was significant reduction in FBS (p<0.01). Proteinuria increased progressively and significantly(p<0.001) while Crcl decreased (p<0.001). The annual rate of increase in proteinuria was 0.077g while Crcl reduced at the rate of 5.13ml/min/1.73m2/year  (p<0.001). Despite glycaemic andBP control, proteinuria increased while Crcl decreasedover the years but at lower rates than predicted for  proteinuric diabetic patients. None of the patients needed renal  replacement therapy by the end of study. Early and intensive glycaemic control, anti-hypertensive and  anti-proteinuric therapies(use of angiotensin converting enzyme inhibitors-ACEIs and angiotensin receptor  blockers-ARBs) can retard progressive nephropathy in Nigerian type2 diabetes mellitus patients.