Diabetic nephropathy and multiorgan protection. Part II

Diabetic nephropathy (DN) presents a complex pathogenesis in which both the vascular system and the metabolism, in its complexity and mainly glucidic metabolism, are involved. Together with the glucid metabolism, lipid metabolism, anemia, oxidative stress, generalised inflammation, vitamin D disorders and smoking participate in DN pathogenesis. All these factors that disturb the homeostasis of the patient with DN require protective factors which will be presented in the second part of the paper. Like hypotensive medication, and especially the inhibitors of the renin angiotensin aldosterone (RAAS) system, antiproteinuric medication, and especially intensive control of glycaemia that have an important protective role, the pathogenic factors mentioned above also require protective measures. As they interest the whole organism in DN and in DM, respectively, we speak about multiple organ protection or multiorgan protection. The concept of multiorgan protection is especially important in DM. Although sometimes, some measures with multiorgan protective character are applied in current practice, it is necessary that they should be gathered and applied within a well established framework, a fact that is achieved by the concept of multiorganprotection. Diabetes mellitus, requires multiple measures of protection because of its vascular and metabolic complications. Diabetic nephropathy represents an important complication of diabetes mellitus, frequently associated with its other complications. The first part of the paper presented the concept of multiorgan protection, as well as some of the main protective measures: control of blood pressure mainly by means of inhibitors of the renine angiotensine aldosterone system, glycaemia monitoring and antiproteinuric treatment. The second part of the paper refers to protective measures used in diabetes mellitus, and diabetic nephropathy, respectively, regarding control of the anaemia, of endothelial disturbances, of the metabolism of lipids, of oxidative stress, of inflammation, smoking, of the metabolism of vitamin D, respectively. Diabetic nephropathy, by the complexity of its lesions, as well as by the complications of diabetes mellitus, cannot be regarded as separate from the organism seen as a unitary whole, a reason because of which the measures of protection are not limited only to the kidney, they must address all organs and metabolism in general, requiring measures of multiorgan protection.