Diabetic patients and kidney protection: an attainable target

Diabetic nephropathy, the major cause of end-stage renal disease in the world occurs as a result of both metabolic and haemodynamic insults, thus emphasizing the importance of optimizing glycaemic and blood pressure control in patients with or at risk of this disorder. The mainstay of antihypertensive therapy is now inhibition of the renin-angiotensisn system involving the use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. The appropriate blood pressure level for the commencement of these drugs and what should be the achieved blood pressure in individuals with diabetes remain controversial. Promising new therapies are currently under preclinical investigation or in early stage clinical trials, and hopefully these newer agents, probably used as adjunct therapies, will further improve the prognosis of individuals with diabetes with early or overt renal disease.