PROMOTION, PREDICTION AND PREVENTION OF PROGRESSION OF NEPHROPATHY INTYPE-1 DIABETES-MELLITUS

The scope of the present review is to discuss the prognosis of diabeti c renal disease, putative progression promoters and the possibilities for treatment and prediction of treatment efficacy. The recent changes in the incidence of diabetic nephropathy in Type 1 diabetes mellitus are discussed. Promoters of progression in diabetic nephropathy are ev aluated, in particular arterial blood pressure, glycaemic control, alb uminuria and cholesterol levels. Potential treatment modalities are di scussed, with special focus on antihypertensive therapy, including a d iscussion of a specific renoprotective action of certain antihypertens ive agents. Furthermore putative predictors of treatment efficacy are evaluated, demonstrating that the ability to lower the urinary albumin excretion rate after onset of treatment heralds a slow progression of the renal disease. The prognosis in diabetic renal disease has improv ed with an increase in median survival after onset of nephropathy from 6 to 15 years. This has exposed the importance of cardiovascular morb idity and mortality. The identification and treatment of cardiovascula r risk factors has become essential. Although the prognosis has improv ed remarkably, the primary goal should be prevention of diabetic nephr opathy, as it is unlikely that the increased risks associated with thi s complication can be eliminated. (C) 1998 John Wiley & Sons, Ltd.