Guidelines for the Treatment of Diabetic Nephropathy*

Diabetic nephropathy is the most devastating complication of diabetes and is now the leading cause of end-stage renal failure in many developed countries. How to halt the steady increase in the number of diabetic patients with end-stage renal failure is a pressing issue in Japan. The most important point for the management of diabetic nephropathy is detecting it as early as possible by regular screening for urinary protein or albumin. Microalbuminuria is a reasonably reliable marker for diabetic nephropathy in the early stage, and the blood glucose and blood pressure levels of microalbuminuric patients should be strictly controlled. Once it progresses to overt proteinuria, glycemic control does not appear to be as effective as in the microalbuminuric stage. Blood pressure control seems to be the main therapeutic approach in those proteinuric patients. ACE inhibitors are the antihypertensive agents of first choice in type 1 diabetics. When the disease has progressed to the stage of chronic renal failure, a low-protein diet should be prescribed to prevent the progression of diabetic nephropathy. In conclusion, early detection of diabetic nephropathy and treatment appropriate to each stage is the best strategy for the management of diabetic nephropathy.