Diabetic nephropathy. What you need to know to preserve kidney function

Patients with diabetes who have a family history of cardiovascular disease or hypertension are at greatly increased risk for development of diabetic nephropathy. The changes that occur in the diabetic hypertensive kidney (mesangial matrix expansion, altered charge and size selectivity of the glomerular basement membrane, and significantly increased intraglomerular pressure) are not generally present in the nondiabetic hypertensive kidney. Angiotensin-converting enzyme (ACE) inhibitors and nondihydropyridine calcium blockers are known to attenuate these changes. Patients taking these agents experience a reduction in the proteinuria associated with nephrotic syndrome; this is accompanied by marked reductions in serum cholesterol level, increases in serum albumin level, and reduced morbidity. Other antihypertensive therapies have not been shown to have these effects. Moreover, ACE inhibitors and alpha blockers have been shown to improve insulin resistance in patients with noninsulin-dependent diabetes. For the patient with diabetes, attention must be given to these factors, and blood pressure medication must be carefully selected.