Nephroprotection in diabetes mellitus.

Area of Science:

• Nephrology
• Endocrinology
• Pharmacology

Background:

• Diabetes mellitus frequently leads to kidney disease, including diabetic nephropathy and end-stage renal disease (ESRD).
• Effective therapeutic interventions are crucial for managing kidney involvement at various stages of diabetes.

Purpose of the Study:

• To analyze the nephroprotective effects of interventions across different stages of diabetic kidney disease.
• To evaluate the impact of treatments on the progression of kidney disease in type 1 (IDDM) and type 2 (NIDDM) diabetes, considering hypertension.

Main Methods:

• A comprehensive MEDLINE search of the past 10 years was conducted.
• Included studies encompassed experimental research, clinical trials, meta-analyses, and editorials on nephroprotection in diabetes mellitus.
• Analysis focused on interventions like glycemic control, protein restriction, and antihypertensive drugs, particularly ACE inhibitors.

Main Results:

• Improved progression in IDDM patients with microalbuminuria or diabetic nephropathy was observed, attributed to glycemic control and antihypertensive treatments.
• ACE inhibitors demonstrated significant benefits, especially in patients with hypertension, though their superiority decreased with rising blood pressure.
• Data regarding the efficacy of interventions for NIDDM patients with diabetic nephropathy is limited and inconclusive.

Conclusions:

• Adequate glycemic control and antihypertensive therapy, especially ACE inhibitors, have positively impacted kidney disease progression in IDDM.
• Further research is needed to establish conclusive treatment strategies for diabetic nephropathy in NIDDM patients.