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Atherosclerosis and Diabetic Nephropathy

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Diabetic Nephropathy

Abstract

Diabetes is associated with the development of various comorbidities, including retinopathy, neuropathy, nephropathy, and cardiovascular disease. The risk of macrovascular complications, such as myocardial infarction and stroke, is increased two- to threefolds when compared to nondiabetics. The increased risk is conferred by accelerated atherosclerosis development. This is mediated through increased plaque inflammation as a result of insulin resistance and hyperglycemia-induced monocyte recruitment as well as activation and proliferation of macrophages in the plaque. Furthermore, endothelial dysfunction and glycocalyx disruption are pathogenic mechanisms that are pivotal in fueling atherosclerosis development. Endothelial dysfunction and glycocalyx disruption are also responsible for the development of albuminuria and renal function decline and forms a pathogenic concept linking diabetic nephropathy and atherogenesis. This may well explain the epidemiologic observation that patients with diabetic nephropathy have a markedly higher risk of cardiovascular events when compared to diabetics without nephropathy. It is therefore critical to acknowledge the cardiovascular hazard that diabetics with albuminuria and/or decline in renal function are facing and to optimize their treatment to minimize the risk of future events.

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  1. Department of Internal Medicine, Section of Nephrology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands

    Raphael Duivenvoorden

  2. Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands

    Raphael Duivenvoorden

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  1. Department of Pathology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands

    Joris J. Roelofs

  2. Department of Internal Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands

    Liffert Vogt

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Duivenvoorden, R. (2019). Atherosclerosis and Diabetic Nephropathy. In: Roelofs, J., Vogt, L. (eds) Diabetic Nephropathy. Springer, Cham. https://doi.org/10.1007/978-3-319-93521-8_22

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