Diabetes increases the risk of different kidney diseases. The most important is diabetic
nephropathy, however, ischemic kidney disease, chronic pyleonephritis and papilla
necrosis may also develop. The prognosis of diabetic nephropathy has improved recently,
however, it is still the primary cause of dialysis and transplantation. Cardiovascular
diseases predict mostly mortality in diabetic patients, however, cerebrovascular insults
and peripheral obstructive arterial diseases necessitating lower limb amputations
are also important. Diabetic retinopathy is almost always present with diabetic nephropathy.
Diabetic neuropathy may also develop, furthermore vascular complications often combine.
All these urge complex workup, follow-up and early treatment. If transplantation is
indicated, preemptive operation should be preferred, and living donation shows the
best outcomes. Different forms of carbohydrate disorder may occur after transplantation:
new-onset diabetes or diabetes known before transplantation may progress. Renal transplantation
with pancreas transplantation may be indicated in type 1 diabetes with end-stage diabetic
nephropathy, most often simultaneously. This may result in normoglycemia and insulin-independence
and the progression of other complications may also halt. Transplant associated hyperglycemia
occurs in most of the patients early, however, it is often transitory. Despite stabilization
of the patient and of the immunosuppressive therapy, about one third of the patients
may develop posttransplant diabetes. Insulin secretion disorder is the primary cause,
but insulin resistance is also needed. Insulin administration may help, however, other
antidiabetics can also be useful. Carbohydrate metabolism should be checked in both
cadaveric and living donors. The authors make an attempt to summarize the above conditions
with Hungarian relevance as well. Orv Hetil. 2018; 159(46): 1930-1939.