Meccanismi e significato clinico del ridotto filtrato glomerulare nel diabete.

Mechanisms and clinical significance of reduced glomerular filtration rate in diabetes Nephropathy, which affects 30-40% of subjects with either type 1 or type 2 diabetes, is characterized by a persistent increase of urinary albumin excretion and a progressive decline of glomerular filtration rate (GFR). Albuminuria and reduced GFR are the main markers of renal damage in diabetes, but they are not sufficiently sensitive and specific to allow an early identification of subjects with renal involvement. Though increased albuminuria characteristically precedes GFR loss in the natural history of diabetic nephropathy, a reduction of GFR may occur also in the absence of albuminuria. This is more frequent in type 2 diabetes, likely due to the more marked anatomical heterogeneity as compared with type 1, possibly underlying a macroangiopathic, in addition to a microangiopathic mechanism. Moreover, not only albuminuria, but also reduced GFR, predict both progression of renal damage and development of cardiovascular disease, which is the main cause of morbidity and mortality in subjects with diabetic nephropathy.