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Chronic renal failure represent one of the more common complications of diabetes. End-stage renal disease develops in about 50% of type 1 (insulin-dependent) diabetic patients between 10 and 30 years from the onset of the disease, and in a consistent number of type 2 (non-insulin-dependent) diabetic patients. In the past, diabetic patients were not included in dialysis programmes, but in the 1980s, in Western countries, a progressively increasing number of them were accepted for renal replacement therapy (RRT). According to the EDTA (European Dialysis and Transplantation Association) Registry, the prevalence of diabetic patients in the dialysis population in Europe varies consistently from country to country (6.8% in France, 9% in Southern Europe, 16% in Germany and 34% in Finland). In Italy, according to the ANED (National Association of Dialysed Patients) Registry, at the end of 1990 1929 of 27106 patients (7.11%) were classified as diabetic. A survey of the diabetic population on RRT was suggested by Catalano in 1988. Palatients were classified as having type 1 diabetes if they required insulin therapy at the start of diabetes or within 2 years of the onset of the disease. The data obtained showed that in Italy the ratio of type 1 to type 2 patients on RRT was 1:3. Another inmportant observation of this survey was that 79% of diabetic patients on RRT were affected by diabetic nephropathy and 21% by other nephropathies complicated by diabetes. About 50% of diabetic patients on RRT in Italy suffered from micro-and macroangiopathy before the start of replacement therapy. It is interesting that in the southern regions of the country the proportion of type 2 diabetic patients was greater than in the north, and that in Sardinia (probably as a result of genetic factors) 71% of diabetics on RRT had type 1 diabetes. In Italy the most common dialysis modality was haemodialysis (81%), while peritoneal diaysis accounted for 14% of patients; only 5% of diabetic patients received a functioning graft. Kidney transplantation should be considered the best form of RRT for diabetic patients, but very few transplants are performed in Italy, mainly as a result of organi procurement problems. More recent data indicate that the number of diabetic patients accepted for RRT is progressively increasing and that about 10 new diabetic patients pmp/year enter Italian RRT programmes. Diabetic patients on RRT have a shorter survival than the general dialysis population and suffer from many important complications. However, their life expectancy, which was very poor in the last decade, is now progressively improving. [ABSTRACT FROM AUTHOR]

Abstract: Background: Pregnancy after kidney transplant has become possible thanks to the recent surgical and pharmacological breakthrough. Materials and Methods: We performed a restrospective study including all childbearing women transplanted in our centers after 1997. The following variables were analyzed: type of nephropathy, patient age when dialysis started, age at transplantation, time between dialysis and transplantation and between transplantation and baby birth. We also considered immunosuppressive therapy, type of delivery, baby weight, Apgar score, and mother and baby follow-up. Results: We followed up 13 pregnancies in 12 patients who were diagnosed with chronic pyelonephritys (n = 4), postpartum cortical necrosis (n = 1), immunoglobulin A GN (n = 4), diabetic nephropathy (n = 1), unknown nephropathy (n = 2). All patients received a cadaveric donor kidney. They were treated with calcium antagonists and alfamethyldopa for their high blood pressure. We observed 9 mother complications: nonnephrotic proteinuria (n = 1), urinary tract Infection (n = 1), pre-eclampsia (n = 4), internal placenta detachment (n = 1) and spontaneous abortions (n = 2); 4 fetal complications: IUGR (n = 2), acute distress respiaratory syndrome (n = 1), Klinefelter syndrome (n = 1) and preterm births (n = 4). In 2 cases the child weight was lower when compared to the gestational age, and 5 babies were admitted to the neonatal intensive care unit. The mother''s follow-up showed no acute rejection episodes. Breastfeeding was discouraged due to the transmission of immunosuppressive medications into breast milk. We did not observe significant disease upon child follow-up. Conclusion: Our data were in agreement with the literature confirming that pregnancy after kidney transplant though possible carries elevated risks. Patients therefore are referred to highly specialized centers where obstetricians, nephrologists, intensivists, and neonatologists provide surveillance and treatment. [Copyright &y& Elsevier]