Carl E Mogensen

Aarhus Kommunehospital/Aarhus University Hospital, Aarhus, Denmark

Several chronic diseases may be without major symptoms or signs for many years; complications in diabetes and hypertension, e.g. early diabetic nephropathy or renal dysfunction, are excellent examples of this important feature [1, 2]. Nevertheless, renal disease may often, without intervention, progress to end-stage renal failure with an eventual need for dialysis or transplantation [3-5]. In fact, diabetes is now one of the major causes of end-stage renal failure in the USA and in Europe, as well as in the rest of the world. In many dialysis units, 30-50% of patients are diabetics [6]. The number of patients with type 2 diabetes developing end-stage renal disease is clearly increasing, as recently reviewed by Ritz and Rychlik [7]. Uraemia in type 1 diabetes is also a major concern. On the other hand, complications of diabetes may be postponed, or hopefully eventually prevented, by early and more effective management [1, 8, 9].

Since there are only a few symptoms or signs of the early stage of the disease, bio-markers should serve to identify those patients at risk of developing renal disease. Together with other organ biomarkers, these should also be used for the evaluation of disease progression, especially with respect to defining the appropriate timepoint for intervention. In addition, biomarkers may also be used to evaluate treatment effect [1]. Usually, long-term follow ups are needed to define clear benefits with respect to preventing organ damage and, more specifically, end-stage renal disease and mortality (Figure 8.1).

Earlier studies indicated that about 30-40% of patients would develop end-stage renal disease and that the remaining would not. Therefore, it was argued that important susceptibility factors could be present, possibly related to genetic factors that could potentially identify patients at risk.

This chapter will survey a number of biomarkers proposed over the years. Obviously, the basis for the disease is its pathology: diabetic glomerulopathy, a slowly and gradually progressive disorder starting in glomeruli with subtle changes

Figure 8.1 Risk factors and risk markers of diabetes and its complications. CHD is coronary heart disease and AMI is acute myocardial infarction.

which are only detectable by morphometry but ending up in total sclerotic and occluded glomeruli. Other parts of the nephron and the kidney may also be involved, but to a lesser and possibly secondary extent [10, 11].

Supplements For Diabetics

Supplements For Diabetics

All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.

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