[Nephropathy in non-insulin-dependent (type-2) diabetes mellitus]

There is a dramatic increase in the incidence of end-stage renal disease in non-insulin dependent diabetes mellitus (NIDDM) requiring renal replacement therapy. The most important risk factors of the onset of nephropathy in NIDDM are genetic predisposition (history of diabetes, hypertension and cardiovascular events in first-degree relatives), hypertension, quality of glycaemic control and smoking. These risk factors play an important role also in the progression of diabetic nephropathy. In about 20-25% of NIDDM patients nondiabetic renal diseases cause the renal damage (other primary nephropathies, ischaemic nephropathy). NIDDM is mainly the part of metabolic x syndrome (hypertension, obesity, dyslipidaemia, impaired glucose tolerance or NIDDM) and, for this reason, all members of metabolic x syndrome has to be involved in treatment strategies e.g. blood pressure "subnormalization", aggressive glycaemic control, cessation of smoking, the treatment of obesity and dyslipidaemia with diet, physical activity and antilipidaemic drugs, as well as restriction of dietary protein and salt intake. The successful prevention and treatment of diabetic nephropathy needs the development of an interdisciplinary interaction that involves general practitioners, diabetologists and nephrologists.