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 onse t of the disease, and 5 years later most patients suffer from end-stag e renal disease. Microalbuminuria, defined as an urinary albumin excre tion rate (UAER) between 30 and 300 mg/day, strongly predicts the deve lopment of nephropathy in IDDM. Nearly all patients with IDDM, a decre asing glomerular filtration rate and a UAER > 300 mg/day have coexisti ng hypertensive disease additionally worsening renal function. We revi ew the results of recent long-term studies of the current therapeutic management in diabetic patients by means of better blood pressure cont rol, low-protein diet and near-normal blood glucose control in the ear ly microalbuminuric phase as well as in the later phases of the diseas e characterized by diabetic nephropathy with a UAER > 300 mg/day. Sinc e the large majority of studies have been performed on IDDM, our concl usions with regard to therapy are only valid in this subgroup of diabe tic patients.