Early diabetic nephropathy. Emerging treatment options.

Diabetic nephropathy affects approximately 35% of patients with insulin-dependent diabetes mellitus and about 5% to 10% of patients with non-insulin-dependent diabetes mellitus. Diabetic kidney disease can be detected early by special methods that measure microalbuminuria in the range of 15 to 140 micrograms/min or 0.02 to 0.20 g/d. Specific strategies have been proved beneficial in patients with this early diabetic kidney disease, also called "incipient nephropathy." Protein restriction, tight control of blood sugar and blood pressure, and specific therapy with angiotensin-converting enzyme inhibitors have been shown independently to reduce microalbuminuria and preserve renal function in these patients. We review the pathogenesis of diabetic kidney disease and discuss the effects of these treatment strategies on the renal, cardiovascular, metabolic, and other abnormalities found in early (incipient) and overt diabetic nephropathy.