1. DIABETIC NEPHROPATHY MADRAS DIABETES RESEARCH FOUNDATION, Gopalapuram, Chennai DIRECTOR & DIABETOLOGIST Dr.Mohan’s DIABETES SPECIALITIES CENTRE Dr. Mohan’s DIABETES SPECIALITIES CENTRE, Anna Nagar, Chennai Dr. Mohan’s DIABETES SPECIALITIES CENTRE, Gopalapuram, Chennai Dr. Mohan’s DIABETES SPECIALITIES CENTRE, Jubilee Hills, Hyderabad India Chennai (Formerly Madras) Hyderabad Dr.Ranjit Unnikrishnan I., M.D.,

2. DIABETIC NEPHROPATHY – MAGNITUDE OF THE PROBLEM Most important cause of morbidity and mortality in Type 1 diabetes – progression is faster 50% with clinical nephropathy reach ESRD by 10 years 75% with clinical nephropathy reach ESRD by 20 years In Type 2 diabetes mellitus progression is slower – 20% reach ESRD About 25 – 50% of all cases of ESRD is due to diabetes ? Racial factors ? Indians / Blacks more susceptible High economic burden on society

3. NATURAL HISTORY OF NEPHROPATHY IN TYPE 1 DIABETES Stage of hyper- filtration Micro albumi- nuria Macro albumi- nuria Azotemia (Renal failure) End stage Renal disease 15 - 20 yrs 1 yrs 4 - 5 yrs Normo albumi- nuria

4. MICROALBUMINURIA AND DIABETIC NEPHROPATHY STAGES Stages Designation Structural GFR UAE BP changes Stage I Hyperfiltration Glomerular = 150 may N or Hypertrophy Hypertrophy be  Stage II Normo  BM  20% - N N albuminuria thickness 30% Stage III Microalbuminuria Further  BM  GFR 20 - 200  thickness  g/min -3mm of Hg

5. MICROALBUMINURIA AND DIABETIC NEPHROPATHY STAGES Stages Designation Structural GFR UAE BP changes Stage Overt Clear and  >200 Hyper- IV Proteinuria Pronounced  g/min tension abnormalities Dipstick positive Stage End stage Glomerular  >200 V Renal closure  g/min Hyper- Disease tension

6. PREVALENCE OF PROTEINURIA CLINIC BASED STUDY ON 1848 TYPE 2 DIABETIC INDIVIDUALS n=1848 Mohan V et al, Postgrad Med J. 2000;76:569-73.