In the initial stage, hyperglycemia increases the glomerular filtration rate and causes glomerular hypertrophy. This condition is already established in 40 percent of patients at the time of diagnosis with diabetes. The microalbuminuric stage develops approximately five years after diagnosis in patients with type 1 diabetes but may occur earlier in patients with type 2 diabetes. Up to 300 mg of albumin may be excreted daily. At more advanced stages of diabetic nephropathy, overt proteinuria, hypertension and reduction in creatinine clearance develop.
Patients rapidly progress to require dialysis or transplantation.
Aggressive prevention is advocated for diabetic nephropathy. Primary prevention includes early detection of diabetes, glycemic control, screening for microalbuminuria, control of hypertension and smoking cessation. The key issues in secondary prevention are glycemic control, reduction of hypercholesterolemia, control of hypertension, smoking cessation, use of ACE inhibitors and possibly restriction of dietary protein. Vocal nodules are benign, symmetric areas of thickening on the medial edge of the vocal folds, usually at the junction of the anterior and middle one third of vocal cords. Patients frequently report that symptoms of hoarseness, throat discomfort and easy vocal fatigue gradually increase throughout the day.