Current practices in the management of diabetic nephropathy

The social and economic burden of treating patients with diabetes mellitus (DM) is rapidly rising. Current projections estimate the global prevalence of individuals with DM to rise from 6.4% (285 million) in 2010 to 7.7% (439 million) in 2030.1 The main problem with this disease entity is its propensity to incur macro- and micro-vascular complications over time, including diabetic nephropathy (DN). Diabetic nephropathy affects approximately one-third of individuals with diabetes. It is the leading cause of end-stage renal disease (ESRD) worldwide, accounting for 42% of all patients on renal replacement therapy (RRT) in the United States.2 The magnitude of this problem has continued to grow in the face of an inexorable rise in the number of diabetic patients. The search for therapeutic modalities to stem this tide remains the quest of many nephrologists. One of the hallmarks of DN is increased urinary protein excretion, and microalbuminuria has long been proposed as an early manifestation of this disease.3,4 Albuminuria and chronic kidney disease (CKD) are strong determinants of cardiovascular disease and to a large extent, the survival of patients with DN is determined by cardiovascular morbidity. Although there remains no cure at present, treatment options to prevent or slow disease progression are available. In this update, we aim to address the current armamentarium in the management of DN.