The Natural History and Epidemiology of Diabetic Nephropathy

PERSONS with diabetes are at increased risk for several types of kidney disease,1but the predominant cause of end-stage renal disease (ESRD) in this disorder is diabetic nephropathy—a complication unique to diabetes. Since the initiation of Medicare coverage for treatment of ESRD in 1972, the proportion of new ESRD cases attributed to diabetic nephropathy has increased from approximately 10% in 19732to 30% in 1987.3Diabetes is now the single most frequent reason for beginning treatment of ESRD, with 10 025 new cases caused by diabetic nephropathy in 1987.3 In this article, we review the natural history and epidemiology of diabetic nephropathy and the evidence for efficacy of preventive and therapeutic measures. From this review, a strategy for preventing and controlling this important cause of morbidity is outlined. NATURAL HISTORY OF DIABETIC KIDNEY DISEASE Diabetic nephropathyis currently defined by the presence of a persistently positive