[Diabetic nephropathy. A historical, clinical and diagnostic framework].

Diabetic nephropathy is the major chronic complication of diabetes mellitus for mortality and morbidity. It is a condition of renal damage appearing in the course of diabetes mellitus, with a clinical expression characterized by urinary signs and arterial hypertension. This condition is functionally distinguished by a progressive decrease of the glomerular filtration rate, and in the Western world it is currently the major determinant of end stage renal disease. In the last twenty years the incidence of renal failure in the course of diabetes mellitus has grown continuously, particularly in type 2 diabetic patients. The majority of patients with diabetic nephropathy reach end-stage renal failure within ten years from the first evidence of proteinuria, and, in the United States, about 30% of the chronically dyalitic patients have diabetic nephropathy. The identification and the control of the renal disease over time are based on the measurement of proteinuria. Although the most useful and reliable dosage methods for proteinuria are still debated, it appears clear today that a spot measurement of albuminuria is not a reliable indication for the diagnosis of diabetic renal disease. The measurement of albuminuria as well as of creatinuria several times a year in the diabetic subject is therefore recommended, considering also that the test needs repetition both when positive and negative. Despite of the relevant results achieved in the last few years by clinical research both in the diagnostic and in the therapeutic fields, the role of prophylactic measures still remains essential in diabetics at higher risk of nephropathy.