Nephrology Dialysis Transplantation, Vol 13, Issue 90008 11-15, Copyright © 1998 by Oxford University Press
G Defarrari, M Repetto, C Calvi, M Ciabattoni, C Rossi and C Robaudo
This brief review will focus on the major factors leading to incipient
diabetic nephropathy (i.e. microalbuminuria) progressing to overt
nephropathy (i.e. macroalbuminuria) and particularly on the role of
glycaemic control and hypertension.Both experimental and cohort studies
support the role of hyperglycaemia in the development of diabetic
nephropathy. Some recent long-term interventional studies in
microalbuminuric patients show conflicting results regarding the role
played by good metabolic control in reducing the incidence of overt
nephropathy. However, strict metabolic control, which is fundamental in
normoalbuminuric patients, is of little use even in microalbuminuric
patients. In general, levels of glycosylated haemoglobin less than two
standard deviations above the upper normal range, commonly <7.5-8%,
seem to protect patients from developing nephropathy.The results of many
cross-sectional studies have shown that the progression of renal damage
regularly is accompanied by arterial hypertension both in insulin-dependent
diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus
(NIDDM). Many long-term interventional studies have been performed in order
to understand the effect of antihypertensive treatment on the incidence of
proteinuria in both normotensive and hypertensive patients with IDDM or
NIDDM. These data show a marked effect of antihypertensive therapy in
preventing the onset of overt nephropathy, and suggest the superiority of
angiotensin-converting enzyme (ACE) inhibitors. We believe that optimal
blood pressure values are 123/70-75 mmHg in younger patients and
125-130/80-85 mmHg in older patients. In conclusion, antihypertensive
treatment, ACE inhibitors per se and possibly strict
metabolic control reduce the development of nephropathy, thus playing a
striking role in the secondary prevention of renal failure.Key
words: diabetic nephropathy; microalbuminuria; therapy of
diabetic nephropathy
ORIGINAL ARTICLES
Diabetic nephropathy: from micro- to macroalbuminuria
Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy; Corresponding author
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