[Specifics of diabetic nephropathy, viewpoint in diabetology: trends of diabetic nephropathy in diabetes].

The evolution of diabetic nephropathy has been studied by Peter Rossing on a cohort of diabetic patients followed at the Steno hospital of Copenhagen during more than 20 years. In the diabetics of type 1, existence of albuminuria at the upper threshold of the normal range, male gender, high blood pressure and poor glycemic control with a very high HbAlc are the main predictive factors of nephropathy evolution. In this population, nephropathy clearly increases the risks of mortality and cardiovascular morbidity. However, the comparison with older studies showed that better control of glycemia, blood pressure and cholesterol, reduction of tobacco consumption and improvement of proteinuria due to antihypertensive treatments, were able to sharply decrease mortality and cardiovascular morbidity with a relative risk reduction of 60%. In type 2 diabetics, besides factors observed in type 1 diabetic patients, the presence of anemia is a predictive criterion of nephropathy progression. In these patients, prevention keys lie not only in the control of glycemia and blood pressure as in type 1 diabetics, but also in that of anemia.