The glycemic control and temporal characteristics of diabetes as risk factors for the occurence of diabetic renal disease.

Diabetes is one of the most spread pandemy, which affects nowadays the world, its incidence increasing globally. The chronic complications of diabetes are extremely important, out of which the diabetic kidney disease (DKD) being by far the most expensive and severe. On the basis of statistic studies, we tried to identify the risk factors within some epidemiological studies. The research started in two directions: the hypothesis of environmental factors and associated diseases and the hypothesis of genetic factors. In this article we are trying to assess the role of glycaemic control, age, total duration and post-pubertal duration of diabetes as risk factors for diabetic nephropathy. The glycaemic control proved to be an essential risk factor in developing microvascular complications and DKD, the "normal" glycaemia being the only limit below which there are no microvascular complications. We do not know for sure exactly the role played by the total duration of diabetes and age in developing the diabetic nephropathy as well as other microvascular complications. The age of onset and the post-pubertal duration seem to be better associated to the development of nephropathy, but the causality has not been demonstrated yet. These are a part of the 21 risk factors quoted in the speciality literature as influencing the occurrence of DKD.

[Puberty, pregnancy, gender and hormonal status--putative risk factors for diabetic nephropathy]. / Pubertatea, sarcina, sexul si statusul hormonal--posibili factori de risc pentru nefropatia diabetica.

Contemplation of non-genetic risk factors that are influencing the onset and development of diabetic nephropathy (diabetic kidney disease--DKD) is very important. This article is integrative, assessing the existent data about several possible risk factors for DKD. Because the age of onset and postpubertal duration of diabetes seems to be strongly correlated with DKD, it is feasible for puberty to be another independent risk factor. Data analysis regarding puberty and possible explanatory mechanisms to link it with DKD, as the connection with DKD of other situations, with special hormonal status (like pregnancy), is also part of this article. Summing up the data about hormonal status, we can conclude that ANF levels are a risk factor for diabetic nephropathy because they are implicated in diminution of urinary Na elimination and hypertension and subsequent urinary albumin excretion (UAE) in case of inadequate glycaemic control. The evidences regarding GH are indicating that it is a risk factor for DKD and that he is probably implicated in glomerular hypertrophy onset at puberty. The urinary elimination levels of GH are very strong correlated with UAE being putative early marker for DKD. Also the GH deficiency seems to be a protective mechanism for DKD apparition. GH is strongly correlated with IGF-1 that has very high urinary levels in microalbuminuric patients. These levels are very well related to UAE, kidney volume--important markers for glomerular hypertrophy. The evidences accumulated until now regarding the role of masculine gender, testosterone and estrogens in DKD are inarticulate.