Diabetic nephropathy is the leading cause of
kidney disease in patients starting renal replacement therapy and affects ∼40% of type 1 and type 2 diabetic patients. It increases the
risk of death, mainly from cardiovascular causes, and is defined by increased urinary
albumin excretion (UAE) in the absence of other renal diseases. Diabetic
nephropathy is categorized into stages: microalbuminuria (UAE >20 μg/min and
≤199 μg/min) and macroalbuminuria (UAE ≥200 μg/min). Hyperglycemia, increased
blood pressure levels, and genetic predisposition are the main risk factors for
the development of diabetic nephropathy. Elevated serum lipids, smoking habits,
and the amount and origin of dietary protein also seem to play a role as risk
factors. Screening for microalbuminuria should be performed yearly, starting 5
years after diagnosis in type 1 diabetes or earlier in the presence of puberty
or poor metabolic control. In patients with type 2 diabetes, screening should
be performed at diagnosis and yearly thereafter. Patients with micro- and
macroalbuminuria should undergo an evaluation regarding the presence of
comorbid associations, especially retinopathy and macrovascular disease.
Achieving the best metabolic control (A1c <7%), treating hypertension
(<130/80 mmHg or <125/75 mmHg if proteinuria >1.0 g/24 h and increased
serum creatinine), using drugs with blockade effect on the
renin-angiotensin-aldosterone system, and treating dyslipidemia (LDL cholesterol
<100 mg/dl) are effective strategies for preventing the development of
microalbuminuria, in delaying the progression to more advanced stages of
nephropathy and in reducing cardiovascular mortality in patients with type 1
and type 2 diabetes.
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