Understanding of Diabetic Nephropathy from Kidney and Pancreas Transplantation

Kidney and pancreas transplantation in IDDM patients have helped in the understanding of some important aspects of the pathogenesis of diabetic nephropathy (DN). Studies on renal structure in IDDM kidney transplant (KT) recipients have clarified that: (1) the diabetic milieu is necessary for diabetic glomerular lesions to develop; (2) the natural history of diabetic nephropathy in the renal allograft (RA) parallels that occurring in the native kidney; (3) DN lesions develop linearly over time; and (4) glycaemic control only partially explains the rate of development of glomerular lesions in the RA. Improved glycaemic control or pancreas transplantation (PT): (1) is able to prevent or halt the development of early diabetic glomerular lesions in RA, but (2) normoglycaemia is unable to reverse established diabetic glomerulopathy in long-term IDDM patients with their own kidneys. This chapter reviews these lessons learned from studies on renal structure in IDDM patients undergoing KT and/or PT.