BACKGROUND: Atherosclerosis is a major cause of morbidity and mortality in 
insulin-dependent diabetes mellitus. Recent studies have shown that albuminuria 
is a predictor of cardiovascular disease in these patients and there is a 
particularly high incidence of coronary heart disease in the early stages of 
albuminuria.
AVAILABLE EVIDENCE: A number of established cardiovascular risk factors, such as 
elevated blood pressure, atherogenic changes in the plasma concentrations of 
lipids and lipoproteins, elevated plasma levels of fibrinogen and, probably, 
hyper-reactivity of platelets are present in patients with diabetic nephropathy. 
Further, albuminuria may be a marker of generalized disease in the vascular wall 
of small and large blood vessels. Findings of an elevated rate of transcapillary 
albumin escape, an elevated plasma concentration of von Willebrand's factor and 
impaired fibrinolytic capacity in early diabetic nephropathy support this 
hypothesis.
CONCLUSION: The initial pathophysiological mechanisms involved in diabetic 
nephropathy are still hypothetical and largely unknown.