Progression of chronic renal disease and diabetic nephropathy: a review of clinical studies and current therapy.

Animal studies on the progression of chronic renal disease have limited applicability to humans. However, human kidneys also progressively deteriorate once they have suffered a certain degree of initial damage. Various therapeutic approaches to slowdown the progression of chronic renal disease [low-protein diets, angiotensin converting enzyme (ACE) inhibitors, etc.] seem promising. Large-scale, ongoing clinical studies may offer definitive answers to their place in the management of progressive renal disease. Diabetic nephropathy, the most common cause of end-stage renal failure, follows a distinct course in insulin dependent diabetes mellitus DM (IDDM); this is less well defined in non-insulin dependent DM (NIDDM). Micro-albuminuria is an important hallmark of early diabetic kidney disease, when it may still be amenable to therapeutic interventions. Strict glycemic control, and ACE inhibitors may be beneficial in early stages of diabetic nephropathy. Less is known on use of calcium-channel blockers and low-protein diets in diabetic nephropathy. There is also a paucity of information on management of diabetic nephropathy in type II DM.