Controversies on the prevention of diabetic nephropathy

Renal function declines progressively in patients with diabetic nephropathy and the decline may be slowed by some preventive interventions. Optimized and intensive insulin therapy delays the onset and slows the progression of diabetic nephropathy. Moreover, dietary restriction, avoiding a high protein intake, could be effective in reducing glomerular hyperfiltration. Finally, there is evidence that angiotensin-converting enzyme inhibitors reduce renal damage by one or more mechanisms independent of their antihypertensive effects. Some controversial aspects of the prevention of diabetic kidney disease are presented and discussed.