[Renal complications of diabetes]

Many diabetic patients will develop a nephropathy that will eventually result in end-stage renal failure. The early stage ("incipient") of diabetic nephropathy generally appears after 5 to 20 years of diabetes and is characterized by microalbuminuria (30 to 300 mg/day), which is only detectable by sensitive radio-immuno-enzymatic methods. When a frank proteinuria develops (> 500 mg/day), the glomerular filtration rate inexorably declines, resulting in terminal renal failure after several years. The onset of microalbuminuria or the elevation of blood pressure (above 120-140/80 mmHg) are predictive of a poor evolution and require appropriate preventive therapeutic interventions. These include an optimal control of hyperglycaemia, dietary proteins and salt restriction, and prescription of anti-hypertensive drugs, with a particular benefit ascribed to angio-tension converting enzyme inhibitors (and maybe to certain calcium channel blockers). These interventions have been proven efficient to prevent or slow down the evolution of diabetic nephropathy.