An Update on Diabetic Renal Disease

Abstract

The hope that diabetic nephropathy would lessen with improvements in management appears not to have been realised. Current epidemiological studies report a continued high frequency of this important micro-vascular complication, with a continued excess mortality when increased levels of urinary albumin loss or reduced filtration function occur. While good glycaemic control ameliorates the development of microalbuminuria in type 1 and type 2 diabetes there is increasing evidence that angiotensin-converting enzyme inhibition and angiotensin receptor blockade are ineffective as primary prevention strategies. Blood pressure control remains the mainstay of treating established diabetic renal disease and a multi-factorial intervention approach in those with type 2 diabetes and microalbuminuria appears to be effective in reducing mortality based on data from one study. The Quality Outcomes Framework initiative for general practice in the United Kingdom has resulted in increased screening for diabetic renal disease with an assumed earlier treatment of blood pressure and introduction of blockers of the renin-angiotensin system. Some novel therapies are under investigation but overall the landscape is largely unchanged.