COMPLICATIONS RENALES DU DIABETE

Many diabetic patients will develop a nephropathy that will eventually result in end-stage renal failure. The early stage ('incipient') of diabetic nephropathy generally appears after 5 to 20 years of diabetes and is characterized by microalbuminuria (30 to 300 mg/day), which is only detectable by sensitive radioimmuno-enzymatic methods. When a frank proteinuria develops (500 mg/day), the glomerular filtration rate inexorably declines, resulting in terminal renal failure after several years. The onset of microalbuminuria or the elevation of blood pressure (above 120-140/80 mmHg) are predictive of a poor evolution and require appropriate preventive therapeutic interventions. These include an optimal control of hyperglycaemia, dietary proteins and salt restriction, and prescription of antihypertensive drugs, with a particular benefit ascribed to angiotensin converting enzyme inhibitors (and maybe to certain calcium channel blockers). These interventions have been proven efficient to prevent or slow down the evolution of diabetic nephropathy.SCOPUS: sh.j