The
cardiorenal syndrome in patients with
diabetes mellitus represents a systemic condition that affects both the cardiovascular and renal systems. Diabetes is a well established risk factor for
cardiovascular disease (CVD), and a significant proportion of diabetic patients go on to develop clinically significant nephropathy. In the diabetic state the kidney is involved by progressive
sclerosis/
fibrosis and
proteinuria, due most likely to overactivity of the
transforming growth factor-beta system and, to some extent, the
vascular endothelial growth factor system, respectively. The pathogenesis of CVD in diabetes is multifactorial, involving hemodynamic forces, humoral/metabolic factors, and oxidative stress. Additionally, it has been suggested that endothelial dysfunction may lead to simultaneous development and progression of renal and cardiac pathology in diabetes. The risk of microvascular complications can be reduced by intensive
glycemic control in patients with type 1 and
type 2 diabetes mellitus whereas benefit to the cardiovascular system is less clear. However, intensified intervention involving other CVD risk factors like
hypertension and dyslepidemia and interception of the
rennin-
angiotensin-
aldosterone system in patients with
type 2 diabetes have been shown to be associated with significant reduction in the risk for renal
disease progression that was paralleled by a significant reduction in
cardiovascular disease burden.