Diabetic nephropathy

Diabetic nephropathy (DN) is a common complication of diabetes mellitus. It has a major impact on patient morbidity and mortality, and therefore a profound impact on the delivery of healthcare in this country. It affects more than one-third of patients with type 1 diabetes and an ever-increasing proportion of patients with type 2 diabetes, and is now the single most common cause of end-stage renal failure in Western countries. This article sets out to define the natural history of the disease and its significance in terms of patient morbidity and mortality. Therapeutic strategies are discussed with particular emphasis on the relative importance of glycaemic control, blood pressure treatment and blockade of the renin–angiotensin system. In addition, guidelines are presented on screening, diagnosis and referral to specialist services.