Diabetic nephropathy is a common disorder with a variable presentation and course. Aggressive treatment of risk factors (hyperglycaemia, hypertension and dyslipidaemia) can slow progression of this condition, as illustrated by three patients whose disease courses differ widely.
- Diabetic nephropathy is becoming more common in general practice; around one-third of patients with diabetes have nephropathy.
- Patient presentations with diabetic nephropathy vary, and progression depends on control of risk factors.
- Progression is slowed by good control of hypertension, use of ACE inhibitors, good glycaemic control and proteinuria reduction.
- Newer agents exist for diabetic control but glycaemic control that is too tight can be as harmful as control that is too loose.
- Patients with diabetic nephropathy should be specifically assessed for acid–base and electrolyte disorders.
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