This Journal feature begins with a case vignette highlightinga common clinical problem. Evidence supporting various strategiesis then presented, followed by a review of formal guidelines,when they exist. The article ends with the authors' clinicalrecommendations.
A 60-year-old man was found to have type 2 diabetes mellitustwo months ago. He has a serum creatinine level of 1.5 mg perdeciliter (133 µmol per liter); a dipstick test showsproteinuria (++). His systolic blood pressure is 150 mm Hg,and his diastolic pressure is 90 mm Hg. He smokes half a packof cigarettes daily. What can be . . . [Full Text of this Article]
The Clinical Problem
Strategies and Evidence
Screening for Microalbuminuria
Glycemic Control
Blood-Pressure Control
Areas of Uncertainty
Role of Other Antihypertensive Agents
Combination of Antihypertensive Drugs
Blood-Pressure Goals
Treatment of Dyslipidemia
Protein Restriction
Multidrug Treatment
Smoking Cessation
Can Diabetic Nephropathy Be Prevented?
Guidelines
Conclusions and Recommendations
Source Information
From the Unit of Nephrology, Ospedali Riuniti di Bergamo; and the Clinical Research Center for Rare Diseases, Mario Negri Institute for Pharmacological Research — both in Bergamo, Italy.
Address reprint requests to Dr. Schieppati at Mario Negri Institute, Via Gavazzeni 11, 24100 Bergamo, Italy.
References
Related Letters:
Diabetic Nephropathy
Goto A., Brensing K. A., Raab P., Frotscher U., Remuzzi G., Schieppati A., Ruggenenti P.
Extract |
Full Text |
PDF
N Engl J Med 2002;
347:947-948, Sep 19, 2002.
Correspondence
This article has been cited by other articles:
Ishizawa, K., Izawa-Ishizawa, Y., Dorjsuren, N., Miki, E., Kihira, Y., Ikeda, Y., Hamano, S., Kawazoe, K., Minakuchi, K., Tomita, S., Tsuchiya, K., Tamaki, T.
(2009). Angiotensin II receptor blocker attenuates PDGF-induced mesangial cell migration in a receptor-independent manner. Nephrol Dial Transplant
0: gfp520v2-gfp520
[Abstract][Full Text]
Wu, L. S.-H., Hsieh, C.-H., Pei, D., Hung, Y.-J., Kuo, S.-W., Lin, E.
(2009). Association and interaction analyses of genetic variants in ADIPOQ, ENPP1, GHSR, PPAR{gamma} and TCF7L2 genes for diabetic nephropathy in a Taiwanese population with type 2 diabetes. Nephrol Dial Transplant
24: 3360-3366
[Abstract][Full Text]
Gagliardini, E., Corna, D., Zoja, C., Sangalli, F., Carrara, F., Rossi, M., Conti, S., Rottoli, D., Longaretti, L., Remuzzi, A., Remuzzi, G., Benigni, A.
(2009). Unlike each drug alone, lisinopril if combined with avosentan promotes regression of renal lesions in experimental diabetes. Am. J. Physiol. Renal Physiol.
297: F1448-F1456
[Abstract][Full Text]
Goldenberg, N. M., Silverman, M.
(2009). Rab34 and its effector munc13-2 constitute a new pathway modulating protein secretion in the cellular response to hyperglycemia. Am. J. Physiol. Cell Physiol.
297: C1053-C1058
[Abstract][Full Text]
Huang, W.-F., Huang, B., Yang, Y.-C., Xiao, D.-W., Liu, H., Jiang, W., Hu, Q.
(2009). Application of A Serum Protein Fingerprinting Model in The Diagnosis of Type 2 Diabetic Nephropathy. Lab Med
40: 345-348
[Abstract][Full Text]
Naderi, A. S. A., Reilly, R. F.
(2008). Primary Care Approach to Proteinuria. J Am Board Fam Med
21: 569-574
[Abstract][Full Text]
Izuhara, Y., Sada, T., Yanagisawa, H., Koike, H., Ohtomo, S., Dan, T., Ito, S., Nangaku, M., van Ypersele de Strihou, C., Miyata, T.
(2008). A Novel Sartan Derivative With Very Low Angiotensin II Type 1 Receptor Affinity Protects the Kidney in Type 2 Diabetic Rats. Arterioscler. Thromb. Vasc. Bio.
28: 1767-1773
[Abstract][Full Text]
Ng, D. P.K., Tai, B.-C., Lim, X.-L.
(2008). Is the Presence of Retinopathy of Practical Value in Defining Cases of Diabetic Nephropathy in Genetic Association Studies?: The Experience With the ACE Insertion/Deletion Polymorphism in 53 Studies Comprising 17,791 Subjects. Diabetes
57: 2541-2546
[Abstract][Full Text]
Yang, S. H., Kim, S. J., Kim, N., Oh, J. E., Lee, J. G., Chung, N. H., Kim, S., Kim, Y. S.
(2008). NKT Cells Inhibit the Development of Experimental Crescentic Glomerulonephritis. J. Am. Soc. Nephrol.
19: 1663-1671
[Abstract][Full Text]
Buleon, M., Allard, J., Jaafar, A., Praddaude, F., Dickson, Z., Ranera, M.-T., Pecher, C., Girolami, J.-P., Tack, I.
(2008). Pharmacological blockade of B2-kinin receptor reduces renal protective effect of angiotensin-converting enzyme inhibition in db/db mice model. Am. J. Physiol. Renal Physiol.
294: F1249-F1256
[Abstract][Full Text]
Hohenstein, B., Hugo, C. P.M., Hausknecht, B., Boehmer, K. P., Riess, R. H., Schmieder, R. E.
(2008). Analysis of NO-synthase expression and clinical risk factors in human diabetic nephropathy. Nephrol Dial Transplant
23: 1346-1354
[Abstract][Full Text]
Ohno, T., Takamoto, S., Motomura, N.
(2008). Diabetic Retinopathy and Coronary Artery Disease From the Cardiac Surgeon's Perspective. Ann. Thorac. Surg.
85: 681-689
[Abstract][Full Text]
Sloan, F. A., Bethel, M. A., Ruiz, D. Jr, Shea, A. H., Feinglos, M. N.
(2008). The Growing Burden of Diabetes Mellitus in the US Elderly Population. Arch Intern Med
168: 192-199
[Abstract][Full Text]
de Cavanagh, E. M. V., Ferder, L., Toblli, J. E., Piotrkowski, B., Stella, I., Fraga, C. G., Inserra, F.
(2008). Renal mitochondrial impairment is attenuated by AT1 blockade in experimental Type I diabetes. Am. J. Physiol. Heart Circ. Physiol.
294: H456-H465
[Abstract][Full Text]
Dihazi, H., Muller, G. A., Lindner, S., Meyer, M., Asif, A. R., Oellerich, M., Strutz, F.
(2007). Characterization of Diabetic Nephropathy by Urinary Proteomic Analysis: Identification of a Processed Ubiquitin Form as a Differentially Excreted Protein in Diabetic Nephropathy Patients. Clin. Chem.
53: 1636-1645
[Abstract][Full Text]
Tsunenari, I., Ohmura, T., Seidler, R., Chachin, M., Hayashi, T., Konomi, A., Matsumaru, T., Sumida, T., Hayashi, N., Horie, Y.
(2007). Renoprotective effects of telmisartan in the 5/6 nephrectomised rats. Journal of Renin-Angiotensin-Aldosterone System
8: 93-100
[Abstract]
Otu, H. H., Can, H., Spentzos, D., Nelson, R. G., Hanson, R. L., Looker, H. C., Knowler, W. C., Monroy, M., Libermann, T. A., Karumanchi, S. A., Thadhani, R.
(2007). Prediction of Diabetic Nephropathy Using Urine Proteomic Profiling 10 Years Prior to Development of Nephropathy. Diabetes Care
30: 638-643
[Abstract][Full Text]
Ruggenenti, P., Perna, A., Ganeva, M., Ene-Iordache, B., Remuzzi, G., for the BENEDICT Study Group,
(2006). Impact of Blood Pressure Control and Angiotensin-Converting Enzyme Inhibitor Therapy on New-Onset Microalbuminuria in Type 2 Diabetes: A Post Hoc Analysis of the BENEDICT Trial. J. Am. Soc. Nephrol.
17: 3472-3481
[Abstract][Full Text]
Sprangers, B., Evenepoel, P., Vanrenterghem, Y.
(2006). Late Referral of Patients With Chronic Kidney Disease: No Time to Waste. Mayo Clin Proc.
81: 1487-1494
[Abstract][Full Text]
Griffin, K. A., Bidani, A. K.
(2006). Progression of Renal Disease: Renoprotective Specificity of Renin-Angiotensin System Blockade. CJASN
1: 1054-1065
[Abstract][Full Text]
Dobesh, P. P.
(2006). Managing hypertension in patients with type 2 diabetes mellitus.. Am J Health Syst Pharm
63: 1140-1149
[Abstract][Full Text]
Hryciw, D. H., Ekberg, J., Ferguson, C., Lee, A., Wang, D., Parton, R. G., Pollock, C. A., Yun, C. C., Poronnik, P.
(2006). Regulation of Albumin Endocytosis by PSD95/Dlg/ZO-1 (PDZ) Scaffolds: INTERACTION OF Na+-H+ EXCHANGE REGULATORY FACTOR-2 WITH ClC-5. J. Biol. Chem.
281: 16068-16077
[Abstract][Full Text]
Lloberas, N., Cruzado, J. M., Franquesa, M., Herrero-Fresneda, I., Torras, J., Alperovich, G., Rama, I., Vidal, A., Grinyo, J. M.
(2006). Mammalian Target of Rapamycin Pathway Blockade Slows Progression of Diabetic Kidney Disease in Rats. J. Am. Soc. Nephrol.
17: 1395-1404
[Abstract][Full Text]
Inagi, R., Yamamoto, Y., Nangaku, M., Usuda, N., Okamato, H., Kurokawa, K., van Ypersele de Strihou, C., Yamamoto, H., Miyata, T.
(2006). A Severe Diabetic Nephropathy Model With Early Development of Nodule-Like Lesions Induced by Megsin Overexpression in RAGE/iNOS Transgenic Mice. Diabetes
55: 356-366
[Abstract][Full Text]
Nangaku, M., Izuhara, Y., Usuda, N., Inagi, R., Shibata, T., Sugiyama, S., Kurokawa, K., van Ypersele de Strihou, C., Miyata, T.
(2005). In a type 2 diabetic nephropathy rat model, the improvement of obesity by a low calorie diet reduces oxidative/carbonyl stress and prevents diabetic nephropathy. Nephrol Dial Transplant
20: 2661-2669
[Abstract][Full Text]
Izuhara, Y., Nangaku, M., Inagi, R., Tominaga, N., Aizawa, T., Kurokawa, K., van Ypersele de Strihou, C., Miyata, T.
(2005). Renoprotective Properties of Angiotensin Receptor Blockers beyond Blood Pressure Lowering. J. Am. Soc. Nephrol.
16: 3631-3641
[Abstract][Full Text]
Coward, R. J.M., Welsh, G. I., Yang, J., Tasman, C., Lennon, R., Koziell, A., Satchell, S., Holman, G. D., Kerjaschki, D., Tavare, J. M., Mathieson, P. W., Saleem, M. A.
(2005). The Human Glomerular Podocyte Is a Novel Target for Insulin Action. Diabetes
54: 3095-3102
[Abstract][Full Text]
Araki, S.-i., Haneda, M., Sugimoto, T., Isono, M., Isshiki, K., Kashiwagi, A., Koya, D.
(2005). Factors Associated With Frequent Remission of Microalbuminuria in Patients With Type 2 Diabetes. Diabetes
54: 2983-2987
[Abstract][Full Text]
Song, K.-H., Ko, S. H., Kim, H.-W., Ahn, Y.-B., Lee, J.-M., Son, H.-S., Yoon, K.-H., Cha, B.-Y., Lee, K.-W., Son, H.-Y.
(2005). Prospective Study of Lipoprotein(a) as a Risk Factor for Deteriorating Renal Function in Type 2 Diabetic Patients With Overt Proteinuria. Diabetes Care
28: 1718-1723
[Abstract][Full Text]
Lea, J., Greene, T., Hebert, L., Lipkowitz, M., Massry, S., Middleton, J., Rostand, S. G., Miller, E., Smith, W., Bakris, G. L., for the African American Study of Kidney Disease a,
(2005). The Relationship Between Magnitude of Proteinuria Reduction and Risk of End-stage Renal Disease: Results of the African American Study of Kidney Disease and Hypertension. Arch Intern Med
165: 947-953
[Abstract][Full Text]
Ruggenenti, P., Fassi, A., Ilieva, A. P., Bruno, S., Iliev, I. P., Brusegan, V., Rubis, N., Gherardi, G., Arnoldi, F., Ganeva, M., Ene-Iordache, B., Gaspari, F., Perna, A., Bossi, A., Trevisan, R., Dodesini, A. R., Remuzzi, G., the Bergamo Nephrologic Diabetes Complications Tri,
(2004). Preventing Microalbuminuria in Type 2 Diabetes. NEJM
351: 1941-1951
[Abstract][Full Text]
de Zeeuw, D., Remuzzi, G., Parving, H.-H., Keane, W. F., Zhang, Z., Shahinfar, S., Snapinn, S., Cooper, M. E., Mitch, W. E., Brenner, B. M.
(2004). Albuminuria, a Therapeutic Target for Cardiovascular Protection in Type 2 Diabetic Patients With Nephropathy. Circulation
110: 921-927
[Abstract][Full Text]
Cruzado, J. M., Lloberas, N., Torras, J., Riera, M., Fillat, C., Herrero-Fresneda, I., Aran, J. M., Alperovich, G., Vidal, A., Grinyo, J. M.
(2004). Regression of Advanced Diabetic Nephropathy by Hepatocyte Growth Factor Gene Therapy in Rats. Diabetes
53: 1119-1127
[Abstract][Full Text]
Nesbitt, K. N.
(2004). An Overview of Diabetic Nephropathy. Journal of Pharmacy Practice
17: 75-79
[Abstract]
McFarlane, S. I., Winer, N., Sowers, J. R.
(2003). Role of the Natriuretic Peptide System in Cardiorenal Protection. Arch Intern Med
163: 2696-2704
[Abstract][Full Text]
Wilmer, W. A., Rovin, B. H., Hebert, C. J., Rao, S. V., Kumor, K., Hebert, L. A.
(2003). Management of Glomerular Proteinuria: A Commentary. J. Am. Soc. Nephrol.
14: 3217-3232
[Abstract][Full Text]
Chobanian, A. V., Bakris, G. L., Black, H. R., Cushman, W. C., Green, L. A., Izzo, J. L. Jr, Jones, D. W., Materson, B. J., Oparil, S., Wright, J. T. Jr, Roccella, E. J., the National High Blood Pressure Education Program,
(2003). Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension
42: 1206-1252
[Abstract][Full Text]
Sarnak, M. J., Levey, A. S., Schoolwerth, A. C., Coresh, J., Culleton, B., Hamm, L. L., McCullough, P. A., Kasiske, B. L., Kelepouris, E., Klag, M. J., Parfrey, P., Pfeffer, M., Raij, L., Spinosa, D. J., Wilson, P. W.
(2003). Kidney Disease as a Risk Factor for Development of Cardiovascular Disease: A Statement From the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Hypertension
42: 1050-1065
[Full Text]
Sarnak, M. J., Levey, A. S., Schoolwerth, A. C., Coresh, J., Culleton, B., Hamm, L. L., McCullough, P. A., Kasiske, B. L., Kelepouris, E., Klag, M. J., Parfrey, P., Pfeffer, M., Raij, L., Spinosa, D. J., Wilson, P. W.
(2003). Kidney Disease as a Risk Factor for Development of Cardiovascular Disease: A Statement From the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Circulation
108: 2154-2169
[Full Text]
Bruno, G., Biggeri, A., Merletti, F., Bargero, G., Ferrero, S., Pagano, G., Perin, P. C.
(2003). Low Incidence of End-Stage Renal Disease and Chronic Renal Failure in Type 2 Diabetes: A 10-year prospective study. Diabetes Care
26: 2353-2358
[Abstract][Full Text]
Levey, A. S., Coresh, J., Balk, E., Kausz, A. T., Levin, A., Steffes, M. W., Hogg, R. J., Perrone, R. D., Lau, J., Eknoyan, G.
(2003). National Kidney Foundation Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification. ANN INTERN MED
139: 137-147
[Abstract][Full Text]
Bruno, G., Merletti, F., Biggeri, A., Bargero, G., Ferrero, S., Pagano, G., Perin, P. C.
(2003). Progression to Overt Nephropathy in Type 2 Diabetes: The Casale Monferrato Study. Diabetes Care
26: 2150-2155
[Abstract][Full Text]
Benigni, A., Zoja, C., Corna, D., Zatelli, C., Conti, S., Campana, M., Gagliardini, E., Rottoli, D., Zanchi, C., Abbate, M., Ledbetter, S., Remuzzi, G.
(2003). Add-On Anti-TGF-{beta} Antibody to ACE Inhibitor Arrests Progressive Diabetic Nephropathy in the Rat. J. Am. Soc. Nephrol.
14: 1816-1824
[Abstract][Full Text]
Molitch, M. E., Fujimoto, W., Hamman, R. F., Knowler, W. C.
(2003). The Diabetes Prevention Program and Its Global Implications. J. Am. Soc. Nephrol.
14: S103-107
[Abstract][Full Text]
Kramer, H. J., Nguyen, Q. D., Curhan, G., Hsu, C.-y.
(2003). Renal Insufficiency in the Absence of Albuminuria and Retinopathy Among Adults With Type 2 Diabetes Mellitus. JAMA
289: 3273-3277
[Abstract][Full Text]
Nangaku, M., Miyata, T., Sada, T., Mizuno, M., Inagi, R., Ueda, Y., Ishikawa, N., Yuzawa, H., Koike, H., van Ypersele de Strihou, C., Kurokawa, K.
(2003). Anti-Hypertensive Agents Inhibit In Vivo the Formation of Advanced Glycation End Products and Improve Renal Damage in a Type 2 Diabetic Nephropathy Rat Model. J. Am. Soc. Nephrol.
14: 1212-1222
[Abstract][Full Text]
Wolf, G., Ritz, E.
(2003). Diabetic Nephropathy in Type 2 Diabetes Prevention and Patient Management. J. Am. Soc. Nephrol.
14: 1396-1405
[Full Text]
McFarlane, S. I., Sowers, J. R.
(2003). Aldosterone Function in Diabetes Mellitus: Effects on Cardiovascular and Renal Disease. J. Clin. Endocrinol. Metab.
88: 516-523
[Full Text]
Levey, A. S.
(2002). Nondiabetic Kidney Disease. NEJM
347: 1505-1511
[Full Text]
Goto, A., Brensing, K. A., Raab, P., Frotscher, U., Remuzzi, G., Schieppati, A., Ruggenenti, P.
(2002). Diabetic Nephropathy. NEJM
347: 947-948
[Full Text]
Star, R., Hostetter, T., Hortin, G. L.
(2002). New Markers for Kidney Disease. Clin. Chem.
48: 1375-1376
[Full Text]
Previous
