Importance of pharmacological intervention for diabetic nephropathy as related to its epidemiological consequences
Abstract
The main aetiological factor in diabetic nephropathy (DN) is hyperglycaemia, while the main factor to accelerate its course is hypertension. Two stages are of clinical importance - incipient and manifest DN.
The incipient phase is characterised by positive microalbuminuria (30-300 mg/24 hours), and the main interventions of relevance to prevent progressive reduction of renal function include diabetes control, treatment of hypertension, and especially therapy with drugs acting on the renin- -angiotensin system. The manifest phase of DN already shows the presence of proteinuria.
It correlates with severe glomerular damage, and increasing proteinuria is accompanied by progressively reduced glomerular filtration rate. A patient without treatment usually develops renal insufficiency 5-8 years after the manifestation of proteinuria already.
Very intense therapy, the main component of which is blood pressure reduction (with antihypertensive drugs) to values less than 125/75 mmHg, reduces the progression rate of glomerular filtration to 50%. As impaired renal function in patients with diabetes results may occur for other etiological reasons as well the general term of "diabetic kidney disease" has been used recently.