Clinical Trials in Overt Diabetic Nephropathy
There is only limited data available regarding how overt diabetic nephropathy should be treated to arrest the progressive decline in renal function. There is agreement on that antihypertensive treatment should be aggressive and that ACE-inhibitors offers an advantage but other interventions, such as improved metabolic control is still controversial. In non-diabetic renal disease, intensive antihypertensive treatment adds only little benefit . In contrast to this, several studies have shown that aggressive antihypertensive treatment is probably the most important factor to determine the rate of decline in kidney function in diabetic nephropathy. The evidence that antihypertensive treatment can preserve renal function is based on the much reduced rate of renal disease progression after effective blood pressure control [2,3]. These studies compare the rate of decline in glomerular filtration rate during intervention with retrospective data. This is not ideal since uncontrolled factors might influence the outcome. However, the effect of antihypertensive treatment is so profound that it is obviously very important for the kidney in diabetic nephropathy. Anyone that treats these patients observe that end-stage renal failure is postponed by antihypertensive treatment and that the disease runs an accelerated course during uncontrolled hypertension. It is a generally held opinion that once established, overt diabetic nephropathy does not benefit from more intense blood-glucose control.
KeywordsPlacebo Filtration Albumin Creatinine Angiotensin
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