RENAL-FUNCTION DOES NOT ALWAYS PREDICTABLY DETERIORATE IN BLIND INSULIN-DEPENDENT DIABETICS WITH NEPHROPATHY

Two insulin-dependent diabetic women with severe retinopathy who were referred for the management of nephrotic syndrome are presented. On th e basis of clinical risk factors, such as retinopathy and severe hyper tension, both patients were expected to develop progressive end-stage renal failure. One woman has shown a gradual decline in creatinine cle arance over 7 years while the plasma creatinine of the other has remai ned normal for 11 years. The unexpectedly good outcome of both these p atients may be related to maintaining a normal blood pressure despite neither patient receiving a prolonged course of an angiotensin-convert ing enzyme inhibitor. Because of the efficacy of current antihypertens ive therapy, the outcome of diabetic nephropathy cannot be so easily p redicted and needs to be formally reassessed.