Med. praxi. 2011;8(6):259-264

New advances in treating diabetic nephropathy

prof.MUDr.Vladimír Tesař, DrSc.

Klinika nefrologie 1. LF UK a VFN, Praha

Diabetic nephropathy is the most common cause of terminal renal failure in developed countries. Albuminuria precedes the development

of manifest diabetic nephropathy in most diabetic patients and is also the most significant predictor of cardiovascular mortality/

morbidity in these patients. Progression of albuminuria can be favourably affected by both good metabolic control of diabetes and good

blood pressure control. Angiotensin-converting enzyme inhibitors and angiotensin antagonists reduce albuminuria and slow down

(but do not stop) the progression of chronic renal insufficiency. Despite this treatment, most patients will develop terminal renal failure

unless they die of cardiovascular disease before that. Combining both drugs is not likely to have a greater antiproteinuric effect than

monotherapy with an angiotensin-converting enzyme inhibitor. A further reduction in albuminuria (or proteinuria) in diabetic patients

can be achieved by using the direct renin inhibitor aliskiren or endothelin antagonists. The high cardiovascular mortality/morbidity of

patients with diabetic nephropathy can be lowered by reducing albuminuria and decreasing systolic blood pressure. Angiotensin antagonists

reduce the risk of heart failure in patients with diabetic nephropathy; the evidence of a beneficial effect of renin-angiotensin

system inhibition on the risk of myocardial infarction is less unequivocal.

Keywords: diabetic nephropathy, microalbuminuria, angiotensin antagonist, renin inhibitor, aliskiren, endothelin antagonist, glycated Hb, blood pressure, dyslipidaemia

Published: July 1, 2011  Show citation