Nephroangiosclerosis and diabetic nephropathy
DOI:
https://doi.org/10.35954/SM1998.20.1.3Keywords:
Ischemic Glomeruli; Renal Insufficiency; Nephroangiosclerosis; Diabetic Nephropathy; Blood Pressure.Abstract
The incidence of end-stage renal failure due to nephroangiosclerosis and diabetic nephropathy has increased in recent years, despite better control of blood pressure (BP), so that figures equal to or less than 130/85 mmHg are currently required to halt or slow its progression. Nephroangiosclerosis is most commonly associated with essential arterial hypertension (AHT), with involvement of medium and small caliber arteries being the specific lesion at the renal level, generally accompanied by ischemic glomeruli. It can be manifested by renal failure (RF) or proteinuria, both of which are potent risk factors for cardiovascular death. Type II diabetics (D II), given the high prevalence of essential hypertension, can present both nephroangiosclerosis and diabetic nephropathy, isolated or combined. According to figures from personal observations, there is a higher incidence of kidney failure due to nephroangiosclerosis than to diabetic nephropathy in this population. Given that the progression of kidney failure is 3 to 4 times slower in nephroangiosclerosis, there is less chance of requiring renal function replacement therapy because they die earlier, generally from cardiovascular causes. This would explain why in D II on hemodialysis diabetic nephropathy prevails over nephroangiosclerosis as a cause of terminal renal failure. In conclusion, it is important and of prognostic value to establish the differential diagnosis between both nephropathies in D II, prioritizing the need for strict BP control, in addition to that of glycemia, in this population.
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