Diabetic nephropathy-pathophysiology and management.

Diabetes mellitus is the leading cause of end-stage renal disease in the United States. Between 1996 and 2001, the prevalence of diabetes in the Medicare population increased by 319%. Patients with diabetes account for approximately one-third of all cases of end-stage renal disease (ESRD). This number is expected to rise dramatically as a result of the growing incidence of diabetes and the aging population. A major complication of diabetes includes end-stage renal disease as a result from diabetic nephropathy. The earliest clinical evidence that nephropathy exists is the appearance of low, yet abnormal, levels of albumin in the urine, referred to as microalbuminuria. This can progress to proteinuria representing overt diabetic nephropathy. Prevention remains the best way to reduce mortality and maintain a high quality of life in these individuals as recent clinical trials confirm that it is possible to not only slow down the progression of diabetic nephropathy, but even prevent it from becoming a significant problem. This article reviews the pathogenesis, diagnostic screening, and treatment strategies of diabetic nephropathy.