Prevention of Diabetic Nephropathy

Abstract

Diabetes mellitus is often described as a syndrome considering its clinical and pathophysiological manifestations. It results due to relative or absolute insulin deficiency and or resistance. Diabetic nephropathy forms part of the microvascular complications of diabetes mellitus. The incidence is on the increase the world over hence an important cause of morbidity and mortality. Due to higher prevalence of type 2 diabetes in the populace, there are more cases of diabetic nephropathy in type 2 diabetes than in type 1. In addition to genetic and racial predisposition, the initiation and progression of diabetic nephropathy is multi-factorial including glycaemic and other metabolic abnormalities, alterations in systemic and renal haemodynamics and various cytokines and growth factors. Early detection and prompt treatment of diabetic nephropathy is of utmost importance in the prevention of renal failure. In addition to tight glycaemic control, other factors that constitute an insult to the kidneys (like urinary tract infection and analgesic abuse) should be attended to diligently. Hypertension is quite outstanding in this regard hence the need to optimally control it. Use of ACEi and ARBs greatly influence the progression and outcome of nephropathy in diabetics. Other factors that deserve mentioning are: protein restriction, cessation of smoking, reduction in salt intake, and control of lipid; these measures significantly help in the prevention and progression of diabetic nephropathy. A review of relevant literatures was conducted using available medical journals, MEDLINE and Science direct via the internet. Other websites were also visited to source for information. The key words employed were: diabetes mellitus, diabetic nephropathy and renal failure. This review was able to outline measures that should be employed in the prevention and progression of diabetic nephropathy, the importance of early detection of nephropathy in diabetics and the role of protein-sparing drugs (ACEi, ARBs and beta-blockers) and life style modifications. To achieve a significant reduction in the number of diabetics presenting with diabetic nephropathy, early diagnosis and surveillance of patients for microalbuminuria, life style modifications, avoiding conditions that constitute an insult to the kidneys, and optimal blood pressure control especially with protein-sparing drugs are of beneficial effect.

Keywords: Diabetes Mellitus, Diabetic Nephropathy, Renal Failure

Nigerian Medical Practitioner Vol. 53 (3) 2008: pp. 28-32