[Early recognition of and treatment possibilities in diabetic nephropathies]

Diabetic nephropathy due to glomerulosclerosis develops in 40% of patients with type I diabetes (in type II the incidence is only around 5%). Two mechanisms are of pathogenetic importance: hemodynamic changes with glomerular hyperfiltration leading to glomerulosclerosis and proteinuria, and biochemical alterations of the glomerular basement membrane consisting of an increase and glycosylation of collagen IV as well as a decrease in negatively charged proteoglycans and sialic acid. Diabetic nephropathy runs through several stages, the first being characterized by hyperfunction and hypertrophy. The appearance of microalbuminuria after 10-15 years of diabetes seems to be a good indicator of the later development of clinically overt nephropathy with large urinary protein losses and decreasing renal function. Successful treatment of hypertension may slow the decrease of renal function. For those patients who have reached terminal renal failure, the treatment modalities of hemodialysis, continuous ambulatory peritoneal dialysis (CAPD) and renal transplantation offer a reasonable chance of prolonging life, although the results are generally less good than in non-diabetic renal patients of the same age group. However, the ultimate goal of therapy must remain the successful prevention of the devastating late sequelae of diabetes, including diabetic nephropathy.