Abstract When last commented on in the Archives two years ago,1 the diabetic renal-retinal syndrome was viewed as a usually serious and often devastating complication of long-standing diabetes for which near-term improvement in prognosis was likely. At that time, it was noted that about half of insulindependent diabetics experience renal failure in a mean of 20 years. Survival of treated uremic diabetics was dismal, with only one in five patients surviving beyond two years of peritoneal dialysis and about one in two living longer than three years after a cadaveric kidney transplant or when sustained by hemodialysis. Interest in diabetic nephropathy since then has been intensified by numerous articles indicating that glomerulosclerosis, the major renal pathological finding in protracted diabetes, is a consequence of hyperglycemia per se. Evidence supporting this contention is drawn from two sources—animal models of diabetes and the fate of renal allografts from nondiabetic donors to diabetic References 1. Friedman EA, L'Esperance F Jr: Diabetic renal-retinal syndrome: The prognosis improves. Arch Intern Med 1980;140:11491150.Crossref 2. Mauer SM, Steffes MW, Brown DM: The kidney in diabetes. Am J Med 1981;70:603.Crossref 3. Najarian JS, Sutherland DER, Simmons RL: Ten year experience with renal transplantation in juvenile onset diabetics. Ann Surg 1979;190:487.Crossref 4. Mauer SM: Understanding and Treatment of Diabetic Nephropathy . New York, Grune & Stratton Inc, 1981. 5. Kennedy AL, Merime TJ: Glycosylated serum protein and hemoglobin Al levels to measure control of glycemia. Ann Intern Med 1981;95:56-58.Crossref 6. McVerry BA, Fisher C, Hopp A, et al: Production of pseudo-diabetic renal glomerular changes in mice after repeated injections of glycosylated proteins. Lancet 1980;1:738-740.Crossref 7. Preud'homme JL, Morel-Maroger L, Brouet JC, et al: Synthesis of abnormal immunoglobulins in lymphoplasmacytic disorders with visceral light chain deposition. Am J Med 1980;69:703-710.Crossref 8. Friedman EA, L'Esperance F Jr: Diabetic Renal-Retinal Syndrome—Prevention and Management , Friedman EA, L'Esperance F Jr (eds). New York, Grune & Stratton Inc, to be published. 9. Najarian JS: Operating on uremic diabetics , in Friedman EA, L'Esperance F Jr (eds): Diabetic Renal-Retinal Syndrome-Prevention and Management . New York, Grune & Stratton Inc, to be published. 10. Oreopoulos DG: CAPD in diabetics , in Friedman EA, L'Esperance F Jr (eds): Diabetic Renal-Retinal Syndrome—Prevention and Management . New York, Grune & Stratton Inc, to be published. 11. Ramsay RC: Comparing visual status in dialysis and transplant diabetics , in Friedman EA, L'Esperance F Jr (eds): Diabetic Renal-Retinal Syndrome—Prevention and Management . New York, Grune & Stratton Inc, to be published.
Archives of Internal Medicine – American Medical Association
Published: Jul 1, 1982