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Diabetes in America, 3rd Edition
Chapter 22: KIDNEY DISEASE IN DIABETES

Figure 22.1 -- Chart showing C K D classification based on albuminuria categories ranging from normal to severely increased and G F R categories ranging from normal to kidney failure
Figure 22.2 -- Line graph showing G F R initially increases in persons with diagnosed diabetes then decreases potentially to E S R D, whereas albumin excretion rises throughout diabetes duration
Figure 22.3 -- Flow chart showing clinical kidney disease progression throughout diabetes progression
Figure 22.4 -- Dot plot showing the distribution of G F R is higher in men with newly diagnosed type 1 diabetes than men without diabetes
Figure 22.5 -- Dot plots showing the distribution of G F R and the effective renal plasma flow are higher in persons with type 2 diabetes than persons without diabetes
Figure 22.6 -- Dot plot showing glomerular basement membrane width and fractional mesangial volume lower in normoalbuminuric persons than those with moderate albuminuria and proteinuria
Figure 22.7 -- Picture showing local podocyte detachment in peripheral glomerular capillaries in a Pima Indian with type 2 diabetes
Figure 22.8 -- Line graph showing the fractional dextran clearance decreases with increasing dextran radius similarly for people with and without diabetes
Figure 22.9 -- Line graph showing people with albuminuria, compared to those with normal albumin, have a higher dextran sieving coefficient among large-radius molecules but not at the low-radius end
Figure 22.10 -- Line graph showing an increase in shunt magnitude at higher levels of fractional clearance of albumin and albumin-to-creatinine ratio
Figure 22.11 -- Line graph showing that shunt magnitude increases at higher levels of foot process width
Figure 22.12 -- Bar graph showing the prevalence of moderate and severe albuminuria was lower in 19 65 to 19 80 in both men and women compared to the prevalence in 19 50 to 19 64
Figure 22.13 -- Line graph showing the prevalence of albuminuria increases with longer duration of type 1 diabetes
Figure 22.14 -- Bar graph showing the prevalence of albuminuria increases with longer duration of type 2 diabetes
Figure 22.15 -- Line graph showing the incidence of kidney disease increased with longer duration of diabetes in 1 study and peaked at 17 years duration and declined afterwards in another study
Figure 22.16 -- Line graph showing the cumulative incidence of persistent albuminuria by duration of diabetes decreased from the early 19 60’s to the late 19 70’s
Figure 22.17 -- Line graph showing the cumulative incidence of diabetic nephropathy by duration of diabetes decreased from the late 19 60’s to the early 19 80’s
Figure 22.18 -- Flow chart showing annual progression to the next stage of C K D was 2% to 2.8% and death occurred in 1.4% with no nephropathy increasing to 19.2% in those with elevated plasma creatinine or E S R D
Figure 22.19 -- Line graph showing the 6-year incidence of proteinuria was 42.9% overall and highest among those with 5 to 9 years duration at baseline
Figure 22.20 -- Bar graph showing the 4-year cumulative incidence of albuminuria was similar in men and women and higher among people with a longer duration of diabetes
Figure 22.21 -- Line graphs showing the relative hazard of death associated with G F R was generally u-shaped regardless of albuminuria status, with the lowest risk between a G F R of 60 and 90
Figure 22.22 -- Bar graph showing death rate is higher among people with a longer duration of diabetes and those with worse kidney disease
Figure 22.23 -- Bar graph showing the people with macroalbuminuria were more likely to have subnormal left ventricular mid-wall shortening and diastolic dysfunction than those without albuminuria
Figure 22.24 -- Line graphs showing that among those with diabetes, adjusted hazard ratios for cardiovascular events was higher at higher levels of U A C R and at lower levels of G F R
Figure 22.25 -- Line graphs showing diabetes is a bigger contributor to E S R D than hypertension, glomerulonephritis, and cystic kidney
Figure 22.26 -- Line graphs showing absolute incident of E S R D has increased from near 0 in 1978 to almost 37,000 in 19 91, with diabetes being the biggest contributor to this increase
Figure 22.27 -- Line graphs showing the incident rate of E S R D increased more in blacks than whites between 19 82 and 20 12, while remaining stable in Hispanics from 19 96 to 20 12
Figure 22.28 -- Line graph showing that 5 and 10 year survival after E S R D diagnosis increased from 19 85 to 20 07 and is higher for those receiving a transplant than dialysis
Figure 22.29 -- Plot showing hazard ratios of death after dialysis initiation was lower in those with a greater degree of American Indian ancestry compared to non-Hispanic whites
Figure 22.30 -- Bar graph showing the 4 year incidence of proteinuria in people with type 1 diabetes was higher among those with higher levels of A1c
Figure 22.31 -- Line graph showing that higher levels of 2-hour glucose at diagnosis and longer duration of diabetes was associated with higher incidence of proteinuria
Figure 22.32 -- Flow chart showing activated pro-sclerotic cytokines are important mediators between metabolic and hemodynamic pathways leading to proteinuria
Figure 22.33 -- Line graphs showing widened glomerular and tubular basement membranes and increased mesangial fraction in those with diabetes compared to an identical twin without diabetes
Figure 22.34 -- Line graphs showing decreases in G B M thickness, T B M thickness, mesangial fractional volume, and mesangial matrix fractional volume 10 years after pancreas transplantation
Figure 22.35 -- Dot plot showing higher blood pressure in parents of type 1 diabetes patients with proteinuria compared to parents of those without proteinuria
Figure 22.36 -- Line graph showing an increase in nocturnal systolic blood pressure was observed in those who developed albuminuria but not those who did not develop albuminuria, regardless of A1c level
Figure 22.37 -- Bar graph showing albuminuria after diabetes diagnosis was more common in those who had higher mean blood pressure before diabetes diagnosis
Figure 22.38 -- Dot plot showing sodium-lithium counter-transport activity was higher with albuminuria than those with normoalbuminuria
Figure 22.39 -- Line graph showing low H D L levels were associated with greater albuminuria in women but not in men
Figure 22.40 -- Bar graph showing the decline in glomerular filtration rate was similar for smokers, ex-smokers, and nonsmokers after adjusting for blood pressure
Figure 22.41 -- Bar graph showing the adjusted odds ratio for albuminuria was higher among those who smoked more in dose-dependent fashion
Figure 22.42 -- Line graphs showing adult-onset compared to youth-onset type 2 diabetes had a cumulative incidence of E S R D that was higher at a comparable duration of diabetes and lower at a comparable age
Figure 22.43 -- Line graph showing intrauterine exposure to diabetes was associated with a 4-fold increase in incidence of E S R D due to younger age of diabetes onset
Figure 22.44 -- Bar graph showing low birth weight children were more likely to have C K D than normal birth weight children after adjustment, while high birth weight was not associated after adjustment
Figure 22.45 -- Bar graph showing 17% of those with a sibling without nephropathy had kidney disease while 83% of those with a sibling with nephropathy had kidney disease
Figure 22.46 -- Bar graph showing proteinuria in 46% of those with both parents having proteinuria, 23% in those with 1 parent with it, and 14% in those with neither parent
Figure 22.47 -- Forest plot showing 24 genetic variants associated with albuminuria or E S R D
Figure 22.48 -- Flow chart showing hyperglycemia-induced epigenetic aberrations alter transcription factors involved in the expression of genes mediating the pathogenesis of diabetic kidney disease
Figure 22.49 -- Line graph showing a higher albuminuria prevalence in those formerly conventionally treated compared to those intensively treated in both the primary and secondary prevention cohort
Figure 22.50 -- Graphs showing 57% lower adjusted risk for moderate albuminuria and 84% lower risk for severe albuminuria in the formerly intensively treated relative to those conventionally treated
Figure 22.51 -- Line graph showing captopril resulted in approximately half the risk of doubling serum creatinine and half the risk of death or E S R D after 4 years of follow-up
Figure 22.52 -- Flow chart demonstrating individualized nature of hypertension management guidelines, taking into consideration factors such as frailty, comorbidities, and albuminuria
Figure 22.53 -- Line graph showing a reduced protein diet resulted in lower risk of death or E S R D

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