DIURETICS IN DIABETIC NEPHROPATHY

Diabetic nephropathy is the major cause of end-stage renal failure in developed countries affecting 30 - 40% of type-I and type-II diabetics . Intention of therapeutic interventions - euglycemic diabetes control , blood pressure control, correction of coexisting general risk factor s - is to prevent glomerular lesion or to slow down the loss of glomer ular filtration rate. ACE inhibitors in particular as well as calcium antagonists have been shown to prevent or to slow down progression of diabetic glomerular lesions in hypertensive type-I and type-II diabeti cs. Therefore they represent the first-line therapy. Patients with hyp ertension mainly due to sodium retention should be treated with diuret ics in addition: with low-dose thiazides in those with normal glomerul ar filtration rate, with loop diuretics in those with reduced glomerul ar filtration rate.