Diabetes increases the risk of different
kidney diseases. The most important is
diabetic nephropathy, however, ischemic
kidney disease, chronic pyleonephritis and papilla
necrosis may also develop. The prognosis of
diabetic nephropathy has improved recently, however, it is still the primary cause of dialysis and
transplantation.
Cardiovascular diseases predict mostly mortality in diabetic patients, however, cerebrovascular insults and peripheral obstructive arterial diseases necessitating lower limb
amputations are also important.
Diabetic retinopathy is almost always present with
diabetic nephropathy.
Diabetic neuropathy may also develop, furthermore vascular complications often combine. All these urge complex workup, follow-up and early treatment. If
transplantation is indicated, preemptive operation should be preferred, and living donation shows the best outcomes. Different forms of
carbohydrate disorder may occur after
transplantation: new-onset diabetes or diabetes known before
transplantation may progress.
Renal transplantation with
pancreas transplantation may be indicated in
type 1 diabetes with end-stage
diabetic nephropathy, most often simultaneously. This may result in normoglycemia and
insulin-independence and the progression of other complications may also halt. Transplant associated
hyperglycemia occurs in most of the patients early, however, it is often transitory. Despite stabilization of the patient and of the immunosuppressive therapy, about one third of the patients may develop posttransplant diabetes. Insulin secretion disorder is the primary cause, but
insulin resistance is also needed.
Insulin administration may help, however, other
antidiabetics can also be useful. Carbohydrate metabolism should be checked in both cadaveric and living donors. The authors make an attempt to summarize the above conditions with Hungarian relevance as well. Orv Hetil. 2018; 159(46): 1930-1939.