How Diabetic Nephropathy progresses to end stage renal disease
What is the natural history of the progression of Diabetic Nephropathy to end stage renal disease (ESRD)?
This question is most clearly answered in patients with nephropathy from type 1 DM, given the readily identifiable onset of DM.
The earliest change of kidney function in DM is kidney hypertrophy and glomerular hyperfiltration occurring in the first 1 to 2 years after diagnosis.
The degree of hyperfiltration correlates with the risk of developing nephropathy. The onset of albuminuria is on average 15 years after the diagnosis of DM and increases in severity over time.
Patients with type 1 DM who have not developed nephropathy after 25 years have a very low risk of developing nephropathy. End-stage kidney disease (ESKD) occurs 20 to 30 years after the onset of diabetes.
Due in part to the unknown time of onset for patients with type 2 DM, moderately increased albuminuria can be seen as early as at the time of diagnosis. In addition, it does not always progress as it does in type 1 DM, because some patients develop diabetes-related loss of kidney function without albuminuria. Patients with DN and type 2 DM are at increased risk of both ESKD and death from cardiovascular disease. Due to increased comorbidities, most patients will die before reaching the need for dialysis.
