DIABETIC NEPHROPATHY - CAN IT BE PREVENTED - ARE THERE RENAL PROTECTIVE ANTIHYPERTENSIVE DRUGS OF CHOICE

Diabetic nephropathy is the most common cause of end-stage renal disea se in the United States. This review focuses on (1) the problem of dia betic nephropathy, (2) hypertension in patients with diabetes mellitus , (3) the pathophysiology of diabetic nephropathy, and (4) therapeutic methods designed to provide renal protection to patients with diabete s mellitus. The treatments discussed are (1) strict metabolic control, (2) strict control of systemic hypertension, (3) control of glomerula r hypertension, and (4) dietary protein restriction. Diabetic nephropa thy can be retarded; renal protection depends primarily on strict meta bolic control and strict control of systemic hypertension. With respec t to the kidney, there are no unique renal protective antihypertensive drugs of choice.