Experimental data in prevention of renal complications in diabetic metabolism.

Microalbuminuria is a marker of manifestation of diabetic nephropathy. Experimental data give evidence for the underlying mechanisms in the development of diabetic nephropathy. Therapeutic measures have developed from which some are still experimental some are already in clinical practice. A strict control of blood glucose is able to prevent diabetic nephropathy in IDDM which is followed by lower morbidity and mortality. Use of ACE-Inhibitors should lead to an effective blood pressure control and a restriction of proteinuria in the case of normotonia. Protein restriction of 0.8 g per kg body weight is recommended. Aldose reductase inhibitors block the polyol pathway resulting a lower intracellular accumulation of sorbitol. Aminoguanidin demonstrates inhibitory effects on advanced glycosylated end products. Both substances are in phase II/III studies. Experimental data suggest a broadening of the armentarium against diabetic nephropathy, e.g. antibodies or selective inhibitors of Amadori product, cytokine receptor antibodies or selective inhibitors of proteinkinase C. The clinical relevance has to be shown by studies in the future. Treatment of comorbid factors like hypertension, smoking, hyperlipidemia and infections should always play an important role in the therapy of diabetic nephropathy.