Diabetic nephropathy

Diabetic nephropathy is the most common cause of end-stage renal disease. Since the disease progresses very slowly and usually takes more than 20 years before terminal renal failure occurs, early intervention is of great importance in order to prevent this disabling complication. A good control of diabetes with HbA(1c) levels around 7% is desirable. At least as important is the treatment of elevated blood pressure values. The target value for patients with diabetes has been adjusted in the last year and is now 130-139/80-85 mmHg. Should (micro-)albuminuria or renal insufficiency be present the blood pressure target is < 130/80 mmHg. For the control of hypertension the use of ACE inhibitors or angiotensin receptor blockers is recommended. In addition, the control of other risk factors and appropriate therapeutic intervention is required. A multifactorial intervention leads to the best results and can avoid the occurrence or progression of diabetic kidney disease and other micro- and/or macrovascular complications.