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Recent advances in diabetic nephropathy
  1. S M Marshall
  1. Correspondence to:
 Professor Sally M Marshall
 School of Clinical Medical Sciences, 4th Floor, William Leech Building, The Medical School, Framlington Place, Newcastle upon Tyne NE2 4HH, UK; s.m.marshallncl.ac.uk

Abstract

Diabetic nephropathy is the leading cause of end stage renal disease worldwide and is associated with increased cardiovascular risk. The earliest clinical manifestation is of microalbuminuria. Tight blood glucose and blood pressure control reduce the risk of microalbuminuria. Once microalbuminuria is present, the rate of progression to end stage renal disease and of cardiovascular disease can be delayed by aggressive management of blood pressure, glucose, and lipids. Inhibition of the renin-angiotensin system is important to reduce intraglomerular pressure but other classes of antihypertensive agent may also be needed to gain adequate control of systemic blood pressure. Such measures can at least half the rate of progression of nephropathy and cardiovascular disease.

  • ACE, angiotensin converting enzyme
  • ATIIRB, angiotensin II receptor antagonist
  • DCCT, Diabetes Control and Complications Trial
  • HbA1c, glycated haemoglobin
  • RRT, renal replacement therapy
  • UKPDS, United Kingdom Prospective Diabetes Study
  • diabetic nephropathy
  • nephropathy
  • microalbuminuria
  • proteinuria
  • diabetes
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