Nephropathy in diabetes mellitus

Nephropathy in diabetics is the number two complication of this disease with a prevalence of 20%-50% in the German outpatient population. Compared to type I diabetes with the typical glomerular diabetic lesions, nephropathy in type 2 diabetes is heterogeneous and frequently the result of hypertensive/vascular or immunological disease. Glomerular filtration rate (formula clearance) and albuminuria/proteinuria are reliable prognostic factors, both associated with cardiovascular morbidity and mortality. Baseline therapy to ameliorate renal failure includes control of the risk factors hyperglycemia, hypertension, and hyperlipidemia together with lifestyle changes. The therapeutic focus in advanced disease stages includes secondary consequences of renal failure (bone disease, acid-base and electrolyte disturbances, anemia, malnutrition). Timely preparation for renal replacement therapy is mandatory. Diabetic patients of all ages benefit from renal transplantation; combined pancreas-kidney transplantation is an option for younger type I diabetics. The diabetic patient benefits most from a multidisciplinary and multiprofessional therapy approach with individual therapeutic goals provided by the general practitioner, diabetologist, cardiologist, and nephrologist. Therapeutic targets in advanced kidney disease are based on limited evidence.