PREVENTION AND TREATMENT OF DIABETIC NEPHROPATHY

The pathophysiology and natural history of diabetic nephropathy are de scribed, and recent developments in its prevention and treatment are d iscussed. Diabetic nephropathy can occur in both insulin-dependent and non-insulin-dependent diabetics. It is characterized by arterial hype rtension, proteinuria, and progressive loss of renal function. Althoug h the exact mechanism has not been fully elucidated, hyperglycemia wit h altered intraglomerular hemodynamics is an important contributor to the initiation and progression of the disease. Concurrent hypertension aggravates progression of the disease. Currently accepted strategies to slow the progression of diabetic renal disease have focused on anti hypertensive therapy, strict glucose control, and restriction of dieta ry proteins. Recent publications support the hypothesis that angiotens in-converting-enzyme inhibitors have a unique ability, independent of their antihypertensive effect, to slow the progression of diabetic nep hropathy. Investigational agents (e.g., aminoguanidine) may prove help ful in the management of the condition. Information about the preventi on of diabetic nephropathy has grown significantly in the past few yea rs.