Diabetic nephropathy: Etiologic and therapeutic considerations

Diabetic nephropathy is the commonest cause of renal failure in the U.S., accounting for one of every three patients entering chronic dialysis programs. Over the last decade the natural history of kidney disease in diabetes has been clearly defined and shown to be similar in IDDM and NIDDM patients. Genetic susceptibility, poor glycemic control, and hypertension have been established as the major risk factors for diabetic nephropathy. Microalbuminuria (30-300 mg/day) represents the earliest clinically detectable abnormality that indicates diabetic renal involvement and occurs approximately 5-8 years before the onset of overt proteinuria (> 300 mg/day). Treatment with intensified glycemic control and antihypertensive agents, especially the angiotensin-converting enzyme inhibitors, has been shown to halt the progression or cause regression of microalbuminuria, indicating the effectiveness of these therapeutic interventions as primary prevention for diabetic nephropathy.