A cumulative incidence of
diabetic nephropathy of 25-40% has been documented after duration of diabetes of at least 25 years in both type 1 and type 2 diabetic patients.
Diabetic nephropathy has become the leading cause (25-44%) of
end-stage renal failure in Europe, the United States and Japan. Until the early 1980s, no renoprotective treatment was available for use in
diabetic nephropathy. Death occurred on average 5-7 years after the onset of persistent
proteinuria. It should be recalled that development of treatment modalities occurred in reverse order: in the early 1980s,
antihypertensive treatment of
diabetic nephropathy was introduced, and in the early 1990s, primary and
secondary prevention with improved glycaemic control and
angiotensin-converting enzyme inhibition. The two main treatment strategies for primary prevention of
diabetic nephropathy are improved glycaemic control and blood pressure lowering, particularly using drugs such as
angiotensin-converting enzyme inhibitors. Megatrials and meta-analyses have clearly demonstrated the beneficial effect of both the above-mentioned treatment modalities.
Secondary prevention, that is, treatment modalities applied to diabetic patients with high risk of development of
diabetic nephropathy (e.g. those with microalbuminuria) has been documented, applying
angiotensin-converting enzyme inhibitors in both type 1 and type 2 diabetic patients. Furthermore, improved metabolic control reduces the risk of progression. In special cases (such as
pancreas transplantation) even reversal of diabetic glomerular lesions has been documented.
Antihypertensive treatment of patients with overt nephropathy induces a reduction in
albuminuria, a reduction in the rate of decline of glomerular filtration rate, delays development of
end-stage renal failure and improves survival. Many potential treatment modalities in preventing and treating
diabetic nephropathy are presently being evaluated.