@entity2316 ( @entity2316 ) is a major cause of morbidity and mortality in @entity1 with both types of @entity6 and the leading cause of @entity454 ( @entity454 ) worldwide. The classical, five-stage natural history of @entity2316 , after an initial phase of hyperfiltration, is characterized by a progressive increase of @entity633 from normoalbuminuria to @entity644 , followed by a decline of glomerular filtration rate (GFR). Accumulating evidence indicates that clinical course of @entity2316 has changed profoundly, likely as a consequence of changes in treatment. In fact, remission/regression of microalbuminuria is a common feature of both type 1 and 2 @entity6 which far outweighs progression to @entity644 . Moreover, GFR loss has been shown to occur independently of @entity633 or even in the absence of it. Nonalbuminuric @entity8 probably represents a different pathway to loss of renal function, which might recognize different pathogenic mechanisms, prognostic implications, and possibly therapeutic measures, as compared with the albuminuric pathway. The nonalbuminuric phenotype might be related to macroangiopathy instead of @entity455 and/or be the consequence of repeated and/or unresolved episodes of @entity810 , even of mild degree. Reduced GFR and @entity633 are both powerful risk factor for cardiovascular events, whereas @entity633 appears to predict @entity204 and progression to @entity454 better than GFR loss. Finally, it is unclear whether reduced GFR and @entity633 warrant different interventions and whether GFR decline may also regress in response to treatment, as @entity644 does. Further epidemiological, pathologic, pathophysiological, and intervention studies are needed to clarify the distinctive features of nonalbuminuric @entity8 .

Updating the natural history of XXXX .

@entity1 :: ('9606', 'Species') :: ['patients'] @entity644 :: ('MESH:D011507', 'Disease') :: ['proteinuria'] @entity8 :: ('MESH:D007674', 'Disease') :: ['renal impairment'] @entity455 :: ('MESH:D014652', 'Disease') :: ['microangiopathy'] @entity6 :: ('MESH:D003920', 'Disease') :: ['diabetes'] @entity2316 :: ('MESH:D003928', 'Disease') :: ['DN', 'Diabetic nephropathy'] @entity633 :: ('MESH:D000419', 'Disease') :: ['albuminuria'] @entity810 :: ('MESH:D058186', 'Disease') :: ['acute kidney injury'] @entity204 :: ('MESH:D003643', 'Disease') :: ['death'] @entity454 :: ('MESH:D007676', 'Disease') :: ['end-stage renal disease', 'ESRD']
@entity2316 :: (MESH:D003928,Disease) :: ['diabetic nephropathy']
