Nephropathy of type II diabetes mellitus.

In recent years there has been a dramatic increase of almost epidemic proportions in the incidence of patients with type II diabetes mellitus who reach end-stage renal failure and enter renal replacement programmes. This is mainly due to the greater prevalence and better survival of patients with type II diabetes and diabetic nephropathy. Against this background measures to prevent the appearance and progression of diabetic nephropathy are of immense interest. Apart from the undoubted role of hyperglycaemia, the importance of genetic determinants of nephropathy has recently been recognized. Factors of proven or suspected efficacy in attenuating progression include: hypertension, hyperglycaemia, smoking and proteinuria. The role of dietary protein intake is less well documented. Nephropathy in type II diabetes has become the single most common cause of end-stage renal failure in Germany and is today a major challenge to clinical nephrology.