Current therapeutic management of diabetic nephropathy.
Roughly 40% of all patients with insulin-dependent diabetes mellitus (IDDM) develop diabetic nephropathy with proteinuria, hypertension and a decrease in glomerular filtration rate 10 to 20 years after the onset of the disease, and 5 years later most patients suffer from end-stage renal disease. Microalbuminuria, defined as an urinary albumin excretion rate (UAER) between 30 and 300 mg/day, strongly predicts the development of nephropathy in IDDM. Nearly all patients with IDDM, a decreasing glomerular filtration rate and a UAER > 300 mg/day have coexisting hypertensive disease additionally worsening renal function. We review the results of recent long-term studies of the current therapeutic management in diabetic patients by means of better blood pressure control, low-protein diet and near-normal blood glucose control in the early microalbuminuric phase as well as in the later phases of the disease characterized by diabetic nephropathy with a UAER > 300 mg/day. Since the large majority of studies have been performed on IDDM, our conclusions with regard to therapy are only valid in this subgroup of diabetic patients.
Kohler
S M
SM
Department of Internal Medicine II, University of Regensburg, Germany.
Krämer
B K
BK
D000419:Albuminuria; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology* / Q000628:therapy; D003925:Diabetic Angiopathies / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000503:physiopathology / Q000628:therapy*; D018753:Diet, Protein-Restricted; D005919:Glomerular Filtration Rate; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology; D011379:Prognosis
D000959:Antihypertensive Agents; D001786:Blood Glucose; D006442:Glycated Hemoglobin