Diabetes mellitus and chronic kidney disease: achievements, unresolved problems, and prospects for therapy

The dramatic increase in the number of patients with diabetes mellitus (DM) and chronic renal disease (CRD) in the recent years emphasizes the close association between the two conditions and the leading role of DM in the development of renal pathology. Diabetology and nephrology are highly costly branches of public health, and the burden of substitution renal therapy in DM patients continues to grow. The necessity of a renoprotection program at the early stages of DM for the prevention or delay of terminal renal insufficiency becomes increasingly clear. Such program should be based on the conceptual model of the evolvement of diabetic nephropathy as a consequence of combined action of metabolic and hemodynamic factors modulated by genetic ones.