[Controlling the progression of diabetic nephropathy]

Diabetic nephropathy is a serious microangiopathic complication of type 1 and 2 diabetes and accounts in a major way for the high morbidity and invalidity of diabetics. Although progression is inevitable when the disease is advanced, there are ways how to prevent its development and retard its progress. Because reliable prediction of diabetic nephropathy is impossible, primary prevention is essential in all diabetic patients. As soon as the diagnosis of diabetes is established, the blood sugar level should be checked systematically and permanent satisfactory compensation of diabetes should be ensured (HbA1c less than 6.5%) which is the main principle throughout the subsequent course of the disease. The principle of secondary prevention the objective of which is to prevent the development of manifest nephropathy with permanent proteinuria, is to monitor microalbuminuria and maintenance of a normal blood pressure. With regard to pathophysiological circumstances in therapy angiotensin converting enzyme inhibitors are preferred. The objective of tertiary prevention is retardation of renal insufficiency by fortified hypotensive therapy, correction of hyperlipoproteinaemia, dietary protein restriction and adequate compensation of diabetes. In case of renal failure dialyzation treatment or transplantation must not be delayed.