"Diabetic nephropathy occurs in one third of patients with type 1 diabetes, with an incidence peak after 15 to 20 years of diabetes," Dr. Per-Henrik Groop, of the University of Helsinki, Finland, and colleagues write. "Diabetic nephropathy clusters in families and in specific ethnic groups, indicating a genetic predisposition," they note. "The genetic risk factors are, however, still largely unknown."

The researchers examined the association between a parental history of hypertension, CVD or diabetes, and diabetic nephropathy in 2355 offspring with diabetes type 1, and if clustering of these traits increased the likelihood of diabetic nephropathy. The team also examined whether total or CVD mortality was increased among the 4676 parents of the patients.
The team defined diabetic nephropathy as macroalbuminuria (urinary albumin excretion rate > 200 mcg/min or > 300 mg/24 h) or end-stage renal disease.

Seven hundred eighty diabetic patients had diabetic nephropathy. Compared with patients without diabetic nephropathy, those with nephropathy had a higher prevalence of parental hypertension (55% versus 62%, respectively), stroke (12% and 15%), and type 1 diabetes (2.9% vs. 4.3).

The odds of diabetic nephropathy were 56% higher in offspring with two parents with hypertension compared with no parents with hypertension.

"Parental mortality and paternal mortality were more prevalent in patients with than without diabetic nephropathy," the researchers report. "No difference was observed in maternal mortality or parental, maternal and paternal CVD mortality."
These findings confirm that familial factors influence the development of nephropathy in type 1 diabetics. Specifically, parental clustering of diabetes type 1, hypertension and diabetes is associated with nephropathy in diabetic offspring.
Diabetes Care 2007;30:1162-1167.

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