[Risk factors in the progression of diabetic nephropathies]

Diabetic nephropathy is a serious long-term complication of diabetes characterized by persistent albuminuria (> 300 mg/24 h or 200 micrograms/min) associated with a decline in GFR, increasing arterial blood pressure, and high risk of cardiovascular morbidity and mortality. Diabetic nephropathy has become the leading cause of end stage renal disease in Europe, USA and Japan. There is a great inter-individual variation in the deterioration in GFR explained by genetic and non-genetic progression promoters (risk factors for losing GFR). In particular arterial blood pressure, glycaemic control, and albuminuria act as non-genetic promoters of progression. These factors are potentially modifiable. Genetic promoters of progression have also been identified, mainly the angiotensin converting enzyme insertion/deletion polymorphism. Knowledge of progression promoters can identify patients with a poor prognosis and direct therapy against modifiable risk factors, in particular hypertension and hyperglycaemia.