Podocyte and Prognosis of Diabetic Nephropathy

In most cases, the prognosis of diabetic nephropathy is poor and this is because renal damage is in a slow progression and the clinical symptoms usually appear in the late stage.

Generally when the disease lasts for more than 10 years there will be proteinuria. It has been confirmed that in the early stage of diabetic nephropathy, there is concealed phase in which there is no clinical manifestations though the glomeruli have been damaged and the only change is the increase of microalbuminuria in the urine.

In clinic, once there is persistent proteinuria, the renal function will experience irreversible and progressive decline. There are about 25% patients will develop into end stage renal failure within 6 years and within 10 years 50%, 15 years 75%. The average time is 10 years from the occuring of proteinuria to develop into anemia and those that have daily urine protein of more than 3g will mostly die within 6 years.

From the statistics above, we can see that more importance and attention should be attached to diabetic nephropathy. The poorly controlled diabetes, high blood pressure, alcohol, tobacco and high-protein diets can all speed up the progression of renal damages and worsen the prognosis. It has been confirmed by recent observation that smoking is one great risk factor of diabetic nephropathy. Among diabetes patients, there are 19% smokers have proteinuria while there is only 8% non-smokers have proteinuria. The prognosis is also related to the renal pathological changes and the diffuse type of diabetes is more likely to progress into renal failure than the nodules type.

Recent study has found that the prognosis of diabetic nephropathy is closely related to the damaged degree of podocytes, therefore it is of high significance to test the concentration of podocytes to evaluate the severity of the illness condition and its prognosis.

Hemodynamic abnormality is the outstanding symptoms of early diabetic nephropathy and the enlargement of the glomeruli and increase of filtration area will cause hypertrophy and loss of podocytes. With the continuous damage of podocytes, microalbuminuria will appear and become worse and worse and the proteinuria will in turn cause further damages to the podocytes and fall into a vicious circle and in the end lead to glomerular sclerosis.