Preventing diabetic nephropathy: the role of primary care

Diabetic nephropathy is the leading cause of end-stage renal disease in the United States and is associated with significant human and economic cost. It is recognized that care of the person with diabetes should be focused on the prevention of the many devastating long-term complications of the disease. The primary care provider is in a key position to implement good preventive care. Monitoring for microalbuminuria is the accepted method for identifying early nephropathy. Individual providers need to be aware of current guidelines for performing screening exams. Once early nephropathy is detected, prudent care with tight glycemic control, angiotension-converting enzyme therapy, control of hypertension, and lifestyle risk-factor modification are warranted. Currently, there is strong indication that the progression of renal disease can be slowed with appropriate early interventions. Positive outcomes are dependent on timely detection of microalbuminuria.