Abstract

DIABETIC NEPHROPATHY: A REVIEW OF CURRENT AND FUTURE PROSPECTIVE

Atul Arya*, Surbhi Rana, Dr. Randhir Singh, Dr. Lakhwinder Singh

ABSTRACT

Diabetic nephropathy is the single most common cause of end-stage renal disease in the world characterised by albuminuria, elevated blood pressure, and a persistent loss of renal function and is associated with greatly increased morbidity and mortality. Adequate control of blood pressure is of paramount importance in delaying the progression of renal disease in diabetic patients. Drugs acting on renin angiotensin aldosterone axis are of proven value in diabetic nephropathy. Particularly angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) have benefits beyond blood pressure control. The disease can be detected by raised urinary albumin excretion microalbuminuria. This allows time for the intensive treatment of glycaemic control, blood pressure and other cardiovascular risk factors, such as lipids, to reduce the morbidity and mortailty. Blockade of the renin-angiotensin-aldosterone system (RAAS) prevents the development and progression of diabetic nephropathy. For patients with high risk of progressive kidney disease potential benefits of dual RAAS blockade on an individual basis will be beneficial. If therapeutic goals are not achieved with an angiotensin converting enzyme inhibitor or angiotensin receptor blockers, then the addition of a nondihydropyridine CCB should be considered. The ever-increasing incidence of diabetic nephropathy has major implications for both patient welfare and health care resources at a time when renal services are already struggling to cope with current demands. However, numerous treatment strategies have been identified that delay the progression of renal disease in diabetes, which is also associated with improved patient Survival.

Keywords: Diabetic nephropathy, Renin angiotensin aldosterone system, Angiotensin