Diabetic Nephropathy

1. Front Matter

   Pages i-xvii

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2. What is Diabetes? Types, Definitions, Epidemiology, Diagnosis

   • Charles M. Peterson, Lois Jovanovic

   Pages 1-8

3. Insulin, Oral Agents, and Monitoring Techniques

   • Charles M. Peterson, Lois Jovanovic

   Pages 9-32

4. Insulin Pumps: For Whom, When, Why?

   • Charles M. Peterson, Lois Jovanovic

   Pages 33-40

5. Clinical Evaluation and Management of Diabetic Retinopathy

   • Francis A. L’esperance Jr

   Pages 41-64

6. Natural History of Diabetic Nephropathy

   • Eli A. Friedman

   Pages 65-83

7. Hemodialysis for the Uremic Diabetic

   • Kathleen Y. Whitley, Fred L. Shapiro

   Pages 85-103

8. Continuous Ambulatory Peritoneal Dialysis in End-Stage Diabetic Nephropathy

   • Ramesh Khanna, Dimitrios G. Oreopoulos

   Pages 105-138

9. Options in Uremia Therapy: Kidney Transplantation

   • Eli A. Friedman

   Pages 139-154

10. Pancreas Transplants in Diabetic Nephropathy

    • David E. R. Sutherland, John S. Najarian

    Pages 155-177

11. Preservation of the Compromised Foot in Diabetic Nephropathy

    • Thomas A. Einhorn

    Pages 179-186

12. Managing the Diabetic Renal-Retinal Syndrome during Pregnancy

    • Charles M. Peterson, Lois Jovanovic

    Pages 187-193

13. Nurse to Nurse: Nursing Role in Diabetic Nephropathy Management

    • Linda S. Cohen

    Pages 195-212

14. Patient to Patient

    • Mildred Friedman

    Pages 213-221

15. Is Diabetic Nephropathy Preventable?

    • Eli A. Friedman

    Pages 223-229

16. Back Matter

    Pages 231-254

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Diabetic nephropathy is a tragic illness. Its often insidious onset in the insulin­ dependent (type I) diabetic, typically a young adult, heralds the last act in the course of a disease that will increasingly become the dominant preoccupation in the patient's shortened life. For most type II diabetics, the beginning of clinical renal insufficiency is but a phase in a continuous deterioration that affects the integrity ofjob, marriage, and family. The nephropathic diabetic is hypertensive, has worsening retinopathy, and more often than not, is also plagued by peripheral vascular insufficiency, heart disease, gastrointestinal malfunction, and deepening depression. Until the 1980's, few type I diabetics who became uremic (because ofdiabetic nephropathy) lived for more than two years. Hardly any attained true rehabilitation. This dismal prognosis is changing substantially for the better. Research in diabetes has resulted in striking advances at both ends of the type I diabetic's natural history. In one exciting clinical trial now underway in London, Ontario, halfofchildhood diabetics treated with cyclosporine within six weeks of onset evince"permanent" disappearanceofhyperglycemia and the need for insulin. At the otherendofthe natural historyofdiabetes for the nephropathic patientwith worsening eye disease (renal-retinal syndrome), who receives a kidney transplant, patient and graft survival, two years after cadaveric kidney transplantation in type I diabetics is now equal to that of the nondiabetic.

• Insulin
• diabetes
• kidney
• transplantation

• Division of Renal Disease, State University of New York, Downstate Medical Center, Brooklyn, USA

  Eli A. Friedman

• Sansum Medical Research Foundation, Santa Barbara, USA

  Charles M. Peterson

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