Chapter 22. Treatment of Nephropathy

  1. R. Williams2,
  2. W. Herman3,
  3. A.-L. Kinmonth5 and
  4. N. J. Wareham4
  1. Akinlolu Ojo

Published Online: 9 APR 2003

DOI: 10.1002/0470846585.ch22

The Evidence Base for Diabetes Care

The Evidence Base for Diabetes Care

How to Cite

Ojo, A. (2002) Treatment of Nephropathy, in The Evidence Base for Diabetes Care (eds R. Williams, W. Herman, A.-L. Kinmonth and N. J. Wareham), John Wiley & Sons, Ltd, Chichester, UK. doi: 10.1002/0470846585.ch22

Editor Information

  1. 2

    Nuffield Institute for Health, University of Leeds, 71-75 Clarendon Road, Leeds LS2 9PL, UK

  2. 3

    Department of Internal Medicine and Epidemiology, 1500 East Medical Center Drive, 3920 Taubman Center, Box 0345, Ann Arbor, MI 48109, USA

  3. 4

    Department of Public Health and Primary Care, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge CB2 2SR, UK

  4. 5

    General Practice and Primary Care Research Unit, Dept. of Public Health & Primary Care, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge CB2 2SR, UK

Author Information

  1. Department of Internal Medicine, University of Michigan Health System, 3914 E Taubman Center, Box 0364, 1500 E Medical Center Drive, Ann Arbor, MI 48109-0364, USA

Publication History

  1. Published Online: 9 APR 2003
  2. Published Print: 27 AUG 2002

ISBN Information

Print ISBN: 9780471988762

Online ISBN: 9780470846582



  • renal failure;
  • risk factor;
  • protein excretion;
  • renal function;
  • serum creatinine;
  • microalbuminuria;
  • proteinuria;
  • renal-angiotensin aldosterone system;
  • protein restriction;
  • pentoxifylline;
  • aminoglycosans;
  • dialysis;
  • kidney transplantation


Diabetic nephropathy is the single most important cause of end-stage renal failure. As a guide to disease management, the natural course of diabetic nephropathy can be divided into four stages, outlined here. Not all diabetic patients develop nephropathy; risk factors include genetic susceptibility, the degree of initial glomerular hyperfiltration, glycemic control and hypertension. Urinary protein excretion and renal function should be quantified in all patients with diabetes. Serum creatinine measurement or endogenous creatinine clearance is usually sufficient to evaluate renal function. The frequency of renal function testing is best determined by individual clinical scenarios. Achievable therapeutic goals should be established for each stage of the disease. Patient education is important in this. Treatment should be directed at preservation of renal function and prevention and treatment of microalbuminuria and overt proteinuria. More specific treatment goals are summarized. Therapeutic options include blockade of the renal-angiotensin aldosterone system, protein restriction, pentoxifylline, aminoglycosans, dialysis and kidney and pancreas transplantation.