[Early diagnosis of diabetic nephropathy]

The history of the nephrological care of diabetic patients may be started with the beginning of the dialysis treatment, when the diabetic population personified the limits of dialysis treatment, a role still played at present. While diabetic patients shifted from being the exception to being the rule on renal replacement therapy (diabetes is the main cause of uraemia in the USA, and one of the most important in Europe), attention was progressively focused on earlier stages of renal failure, following a pathway common to most nephropathies. Presently, the main advantages of an early diagnosis of renal disease in diabetic patients, strictly linked to an early multidisciplinary follow-up, mainly regard: the timing of pancreas-kidney and of isolated pancreas graft in the smaller, albeit complex population of type 1 diabetic patients and, in the growing cohort of type 2 diabetics,, the optimization of low protein diets, the management of the anti-hypertensive polytherapy and the choice of the dialysis treatment, whenever possible in out-of-hospital settings, to reduce the costs and to favour patients' empowerment. These are demanding tasks: to face the needs of this cohort requires time and human resources, a hard and possibly anachronistic goal in a time, such as the present one, of costs restrains. However, if the costs of one year of dialysis (25-30,000 Euros) are considered, the benefit cost ratio appears as highly favourable, not only in terms of quantity and quality of life but also in economical terms.