The pathophysiology of diabetic nephropathy is complex and multifactorial. Two mechanisms have been proposed, both of which are initiated by hyperglycemia. The first mechanism is based on hyperglycemia leading to protein glycosylation that in turn causes glomerular hypertrophy and eventually leads to sclerosis. The second proposes hyperglycemia leading to vasodilatation followed by hyperfiltration, abnormal angiotensin II response, abnormal endothelin/NO response, increased growth hormone secretion, hyperinsulinemia and sclerosis.
