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Nephropathy in the diabetic patient follows a well-established course, beginning with microalbuminuria, progressing to proteinuria, hyperazotemia and culminating in end-stage renal failure. Early nephropathy has also been shown to predict vision-threatening retinal disease in patients with type 1 diabetes. Chronic hyperglycemia is a key factor in microangiopathy because of its rate, duration and likely mediators. The hypothesis of a relationship between the angiotensin-1 converting enzyme gene and the deleterious effects of chronic hyperglycemia is possible through an insertion/deletion polymorphism which in fact influences the frequency of serious cardiac complications in insulin-dependent patients with diabetic nephropathy, a situation characterized by high plasma angiotensin converting enzyme concentrations. This chronic hyperglycemia is related to the poorly understood angiotensin II. Experimentally, growth hormone and insulin like-growth factors, through a complex system, may be responsible for the changes.
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