[Prevention and remission of diabetic nephropathy]

Diabetic nephropathy is the most important cause of end-stage renal failure. Recent clinical trials have postulated the possibility for prevention and remission of the disease once reckoned as irreversible. In DCCT, UKPDS and Kumamoto study, progression to overt proteinuria was prevented by intensive blood glucose control. Lewis study has demonstrated renoprotective effect of ACE inhibitor in type-1 diabetic nephropathy, and RENAAL and IDNT has documented that of angiotensin II type-1 receptor blocker in type-2 diabetes. Moreover, potential efficacy of lipid lowering in prevention of diabetic nephropathy has been postulated in recent Steno-2, multifactorial intervention trial. Thus, simultaneous adjustment on hyperglycemia, hypertension, and dyslipidemia may lead to prevention and remission of diabetic nephropathy.