Mechanisms of diabetic nephropathy

Diabetes leads to end-stage renal disease in a considerable fraction of patients. A number of risk factors for this process can be identified. These include glycemic control, familial and ethnic risks, and hemodynamic alterations in both systemic and intrarenal hypertension. This latter category of hemodynamic risks may interact with metabolic and genetic influences to ultimately produce progressive diabetic nephropathy. However, manipulation of these vascular stresses by antihypertensive therapy presently offers the most efficacious means of influencing the progression and perhaps even clinical appearance of diabetic nephropathy.