Neglected nephropathy.
BACKGROUND: Diabetic nephropathy is a significant contributor to the morbidity, mortality and health care cost among patients with diabetes. With increasing understanding of this problem, the natural progression of diabetic nephropathy can potentially be changed. OBJECTIVE: This article examines the natural history of diabetic nephropathy and provides guidelines on detection, management and future treatment possibilities of this complication. DISCUSSION: Prevention and slowing progression are the most important aspects of the management of diabetic nephropathy. This involves monitoring renal function and risk factors for renal damage and early active intervention. The angiotensin converting enzyme inhibitors and receptor antagonists are important components of therapy, both for controlling hypertension and for slowing the progression of micro and macroalbuminuria. When microalbuminuria occurs, intensive intervention on a range of risk factors can halve the number of those suffering a cardiovascular event or progressing to macroalbuminuria. When renal insufficiency occurs, particularly when creatinine clearance is >30 mL/minute, referral to an nephrologist should be considered.