Early detection and treatment of diabetic nephropathy.

Renal involvement in diabetes, known as diabetic nephropathy (DN), is a progressive disease and occurs as a result of direct and indirect effects of hyperglycemia. DN is a serious public health concern because it is the leading cause of end stage renal disease (ESRD) in most developed countries and is associated with increased cardiovascular mortality and morbidity. DN is characterized by an initial period of glomerular hyperfiltration, associated with progressively increasing proteinuria, followed by a gradual decline in glomerular filtration rate, resulting in ESRD. Prevention of DN depends on awareness of risk factors for DN, screening for microalbuminuria and hypertension, monitoring glycemic control, and initiating or modifying treatment as needed. Risk factors for development of DN include hyperglycemia, hypertension, positive family history of nephropathy and hypertension, and smoking. Significant advances have been made in recent years in understanding the pathogenesis of DN, raising the possibility that newer therapies may prevent or slow the progression of DN.