Renal disease in type 2 diabetes

The prevalence of type 2 diabetes is rising in all Westernized societies. P resumably as a consequence of diminishing cardiovascular mortality, end-sta ge renal failure (ESRF) in patients with diabetes (mostly type 2) as a co-m orbid condition has risen dramatically in the past decade. This constellati on has become the single most common cause of ESRF in most countries. Such an epidemiological trend is particularly regrettable, since in uraemic diab etic patients, medical rehabilitation and survival are remarkably poor. Rec ent studies indicate that an interplay between genetic predisposition and f actors, some of them susceptible to intervention, such as hyperglycaemia, b lood pressure, smoking, age, gender and ethnicity, predispose to the develo pment and progression of nephropathy. It has also become clear that trace a lbuminuria ('micro-albuminuria') provides unique opportunities to recognize incipient renal involvement early on, although it is less specific in type 2 as compared with type 1 diabetes. Factors that promote progression inclu de hypertension, proteinuria, smoking, glycaemic control and, less certainl y, dietary protein intake and hyperlipidaemia. Cumulating evidence indicate s that early intervention delays progression of nephropathy. The most impor tant strategies to combat the medical catastrophe of increasing numbers of diabetic patients with ESRF include: (i) prevention of diabetes (mainly typ e 2): (ii) glycaemic control to prevent onset of renal involvement and (iii ) meticulous antihypertensive treatment to avoid progression of nephropathy .