Diabetic nephropathy: can it be prevented? Are there renal protective antihypertensive drugs of choice?

Diabetic nephropathy is the most common cause of end-stage renal disease in the United States. This review focuses on (1) the problem of diabetic nephropathy, (2) hypertension in patients with diabetes mellitus, (3) the pathophysiology of diabetic nephropathy, and (4) therapeutic methods designed to provide renal protection to patients with diabetes mellitus. The treatments discussed are (1) strict metabolic control, (2) strict control of systemic hypertension, (3) control of glomerular hypertension, and (4) dietary protein restriction. Diabetic nephropathy can be retarded; renal protection depends primarily on strict metabolic control and strict control of systemic hypertension. With respect to the kidney, there are no unique renal protective antihypertensive drugs of choice.