Diabetische nephropathie. Diagnostik, therapie, progressionshemmung und prävention

Diabetic nephropathy is a main microvascular complication in type 1 and type 2 diabetes and at present the leading cause of renal failure. The test for microalbuminuria 30-300 mg/24 h) is an important screening parameter to early establish the diagnosis of diabetic nephropathy. Furthermore, microalbuminuria is a predictor for cardiovascular complications in diabetics. Therapeutic goals are reduction of proteinuria and inhibition of progressive renal insufficiency. A strict blood pressure control is most important (therapeutic objective <130/80 mmHg in normalbuminuric diabetics, <125/75 mmHg in patients with proteinuria >1 g/24 h). Blockade of the renin-angiotensin system with AT1-receptor antagonists and ACE-inhibitors has nephroprotective beneficial effects which may be independent of blood pressure lowering. To reduce cardiovascular complications, a multimodal therapeutic concept with blood pressure and glucose control, optimising the lipid profile and platelet aggregation inhibition is needed.