Treatment of Diabetic Nephropathy: Changing Landscapes and New Horizons

  • Charuhas V. Thakar
    Robert G. Luke Endowed Chair in Nephrology, Professor of Medicine, Director, Division of Nephrology, University of Cincinnati, Cincinnati, OH
    Renal Section, Cincinnati VA Medical Center, Cincinnati, OH
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      Until the early 19th century, diabetes mellitus (DM) was regarded as a disease of the kidney, in which one of the signs was that of an increase in the volume of urine and wasting. Only after the identification of glucose in blood and urine in the late 18th century was it recognized as a metabolic disorder. It was noted in parallel that patients with DM may show presence of coagulable urine containing albumin as a sign of kidney disease. After the advent of availability of insulin in the early 1920s, which led to increased survival, diabetic nephropathy became more apparent. After a few isolated descriptions that were ignored, the now-famous paper of Paul Kimmelstiel and Clifford Wilson appeared in 1935 detailing nodular renal lesions in just 8 maturity-onset (48 to 68 years old) people with diabetes.
      • Cameron J.S.
      The discovery of diabetic nephropathy: from small print to center stage.
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