[Diabetic nephropathy and cardiovascular risk].

The curious case of the Diabetic Nephropathy (DN) : paraphrasing the name of a famous movie is certainly an unusual way to deal with a medical-scientific issue, but it could be extremely functional. Benjamin Button, with his backward life, breaks the unquestionable certainty of human life progressing through fixed steps. Similarly, the knowledge of DN seems go backwards; therefore, although it is a pathology which clinicians are usually sure, maybe too sure, they know every aspect of, the clinical nephrologist managing a diabetic patient often finds himself/herself far from his/her old certainties and proper answers. This review includes the wide range of topics related to DN which have been dealt with in the most recent literature: the epidemiological issue of the disease incidence and prevalence; the natural progress of DN, which can be traced in a classic way with an increasing degree of severity or by presenting the typical phenotype of non-proteinuric forms; the capability to recognize and distinguish DN from other forms of nephropaties in patients with Diabetes Mellitus (DM) ; the role of currently available therapies characterized by the nephroprotective properties of the latest drugs. To date, DN is the first cause of terminal uremia in the Western population, and cardiovascular mortality of these patients is even higher than the risk of dialysis. It is a widespread and serious disease, with several aspects which are still unknown. A curious story with an ending that has to be changed. Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.