Etiology and pathogenesis of diabetic nephropathy have not known, currently considered multifactorial, some genetic basis, and the risk factors under the common disease.
1. Genetic factors
The proportion of diabetic nephropathy in men than in women. Studies in the US there are findings of the same living environment, African and Mexican prone diabetic nephropathy compared with whites. In the same race, some susceptible to diabetic nephropathy families, these are all signs of the presence of genetic factors. in diabetes type 1.40% to 50% occur microalbuminuria, type 2 diabetes during the observation period is only 20% to 30% of diabetic nephropathy occurs, suggesting that genetic factors may play a role.
2. Abnormal Renal Hemodynamic
Diabetic nephropathy in early time can be observed in renal hemodynamic abnormalities, showed glomerular hyperfiltration and high perfusion, renal blood flow and glomerular filtration rate (GFR) increased. And after protein intake increases the degree of increased more significant.
3. abnormal metabolism caused by hyperglycemia
Hyperglycemia primarily hemodynamic and metabolic alterations abnormal renal lead to kidney damage, metabolic abnormalities that cause kidney damage mechanism include: ① disorder in glucose metabolism partial renal tissue through non-enzymatic glycosylation form of glycation end metabolites (AGES) .② Activation polyol pathway. ③ Diacylglycerol - activation of protein kinase c vía.④ Metabolic pathways of glycosaminoglycans is anomalous .In addition to participating in early hyperfiltration metabolic disorders, it is more important to promote thickening of the glomerular basement membrane (GBM) and matrix accumulation extracellular. Increased glomerular hair.
4. Hypertension
Almost any hypertensive diabetic nephropathy in type 1 diabetic nephropathy, hypertension and microalbuminuria occurred in parallel, in type 2 diabetic nephropathy in frequency appear before the hypertension. The control status of blood pressure is closely related to the development of diabetic nephropathy.
5. Abnormal metabolism of vasoactive substances
The development and progression of diabetic nephropathy can be a variety of metabolic abnormalities of vasoactive substances. Include RAS, endothelin family of prostaglandins, growth factors and other metabolic disorders.
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