EXPERIMENTAL-DATA IN PREVENTION OF RENAL COMPLICATIONS IN DIABETIC METABOLISM

Microalbuminuria is a marker of manifestation of diabetic nephropathy. Experimental data give evidence for the underlying mechanisms in the development of diabetic nephropathy. Therapeutic measures have develop ed from which some are still experimental some are already in clinical practice. A strict control of blood glucose is able to prevent diabet ic nephropathy in IDDM which is followed by lower morbidity and mortal ity. Use of ACE-Inhibitors should lead to an effective blood pressure control and a restriction of proteinuria in the case of normotonia. Pr otein restriction of 0.8 g per kg body weight is recommended. Aldose r eductase inhibitors block the polyol pathway resulting a lower intrace llular accumulation of sorbitol. Aminoguanidin demonstrates inhibitory effects on advanced glycosylated end products. Both substances are in phase II/III studies. Experimental data suggest a broadening of the a rmentarium against diabetic nephropathy, e.g. antibodies or selective inhibitors of Amadori product, cytokine receptor antibodies or selecti ve inhibitors of proteinkinase C. The clinical relevance has to be sho wn by studies in the future. Treatment of comorbid factors like hypert ension, smoking, hyperlipidemia and infections should always play an i mportant role in the therapy of diabetic nephropathy.