Nephropathy in non-insulin-dependent diabetics
Bouhanick, B.; Berrut, G.; Fabbri, P.; Fressinaud, P.; Marre, M.
Presse Medicale 25(27): 1251-1256
1996
ISSN/ISBN: 0755-4982 PMID: 8949738 Document Number: 465268
In the USA, diabetic nephropathy is involved in 34% of cases of end stage renal failure. In Europe, five-year survival of diabetics with end renal failure is 31%, compared with 55% in the non diabetic population. Three phenomena are involved in the development of nephropathy in non-insulin-dependent diabetic patients: glomerular hyperfiltration, elevation of urinary albumin excretion and high blood pressure, the latter sometimes being present before the discovery of diabetes. Even if control of blood sugar is improved, various prospective studies have failed to demonstrate any benefic effect in terms of reducing renal failure in non-insulin-dependent diabetic patients. Some data indicate that angiotensin-converting enzyme inhibitors can reduce the amount of proteinuria and slow the progression of diabetic nephropathy in insulin-dependent diabetic patients, but data remain controversial in non-insulin-dependent diabetic patients. Specifically, in these patients, there is no evidence pointing to an advantage of lowering blood pressure with angiotensin converting enzyme-inhibitors to reduce morbidity or mortality.