Hyperglycemia in the long term causes hemodynamical changes in the microcirculation of the kidneys, membrana basalis thickening, increase in the volume of the extracelular matrix, mesangial expansion, fibrosis.

These form the Kimmelstiel-Wilson syndrome. It is characterized by diffuse or nodular glomerulosclerosis afferent and efferent hyaline aterosclerosis, leading  progressively towards renal failure.

Objective:

Verifying if the most common cause of Chronic Kidney disease (CKD) in patients with diabetes is Diabetic Nephropathy, respectively what other factors can be taken into account as triggers of renal damage, and Chronic Kidney Disease (CKD).

Material and Method:

Retrospective study involving 100 patients suffering from both Diabetes Mellitus and Chronic Kidney disease. Patients are from the Mures and Covasna counties in Romania. Patients who are in stage 1 of CKD are excluded from this study because at this stage diagnosis is difficult; patient is asymptomatic, proteinuria and a rise in creatinin may indicate it however. In order to remove inaccuracies we chose to ignore those cases and focus on patients in more advanced stages.

In 68 % of the patients the cause of Chronic Kidney Disease was Diabetic Nephropathy.

In 13% of the patients the trigger was an infection. (1% of the patients have renal TB)

In 10% of the patients the trigger was a combination of hypertension and nephrosclerosis

In 6% of the patients the trigger was obstructive Nephropathy.

In 2% of the patients myeloma was the cause of renal damage.

In 1% of the patients gout was the cause of renal damage.

Covasna county

Mures county

Diabetic Nephropathy-glomerulosclerosis 67,31% 68,75%

Infective 11,54% 14,58%

Mixed: Nephroangiosclerosis+ hypertensive 7,69% 12,50%

Obstructive nephropathy 9,62% 2,08%

Nephropathy due to multiple myeloma 1,92% 2,08%

Renal damage caused by gout 1,92% 0%

Patients suffering of type 1 diabetes : 23%

Patients suffering from insulin dependent type 2 diabetes: 46%

Patients suffering from non insulin dependent type 2 diabetes: 31%

Patients suffering of type 1 diabetes : 29,41%

Patients suffering from insulin dependent type 2 diabetes: 50%

Patients suffering from non insulin dependent type 2 diabetes: 20,59%

Our study has shown that Diabetic Nephropathy is the most significant trigger of Chronic Kidney Disease (CKD) in patients with diabetes. Other triggers such as infection(pyelonephritis), and obstructive nephropathy have proven to be a lot less frequent.

Conclusions:

In patients suffering from Diabetes mellitus the most common cause of Chronic Kidney Disease (CKD) is Diabetic Nephropathy- also known as Kimmelstiel-Wilson syndrome.