Diabetic nephropathy--recent therapeutic concepts

Optimal metabolic control, strict antihypertensive therapy and a low-protein diet may reduce renal functional disorders such as hyperfiltration and microalbuminuria in the initial and latent phase of diabetic nephropathy and may retard progression of renal functional loss in the clinically-manifest proteinuric, azotaemic phase. Increasing clinical experience with renal replacement therapy in the end-stage renal failure of diabetic nephropathy led to a worldwide rise in the percentage of diabetic patients in dialysis centres. However, full rehabilitation is not achieved and retinopathy may progress to complete blindness. As a result of better rehabilitation and possible stabilisation of diabetic neuropathy and retinopathy after renal transplantation, in diabetic patients a kidney graft should be available early in the course of progressing renal failure.