Approach to the treatment of diabetic nephropathy.

Renal failure is a common long-term complication of diabetes mellitus. Stages of diabetic nephropathy have been described that characterize its clinical course. Diabetic nephropathy develops secondary to long-standing hyperglycemia and hemodynamic changes that damage the glomerulus. Therapy that focuses on the control of glomerular pressures and systemic hypertension can slow the progression of proteinuria and deterioration of renal function. Angiotensin converting enzyme (ACE) inhibitors and calcium channel blockers have been demonstrated to be effective in the management of diabetic nephropathy. A systematic approach to the patient with diabetes with annual screening for proteinuria will help identify those individuals early in the course of disease when proper therapy may be most helpful.