The renal involvement in hypertension and type 2 diabetes mellitus: how to identify and to prevent? The vision of the nephrologist

Abstract

Revista HUPE, Rio de Janeiro, 2013;12(Supl 1):53-60

doi:10.12957/rhupe.2013.7083

Approximately 30% of diabetic patients develop diabetic nephropathy, particularly associated with arterial hypertension. Moreover, this disease accounts for 30-40% of patients undergoing chronic dialysis. Chronic renal disease, even if mild, is clearly associated with unfavorable outcomes in diabetic and hypertensive patients. It is actually considered one of the most important nontraditional cardiovascular risk factors. However, it is noteworthy that the cardiovascular risk is independently related to the degree of the renal dysfunction. In contrast to type I DM, type II-associated diabetic nephropathy may be characterized by microalbuminuria at onset, loss of function without microalbuminuria, albuminuria without preceding microalbuminuria, or early and severe vascular disease. The renal pathological findings are heterogeneous, comprising from a mixture of glomerulosclerosis and hypertensive nephroesclerosis to vascular lesions and glomerular ischemia. The recommended approach to prevent and treat diabetic nephropathy is based on: 1) intensive metabolic control; 2) rigorous blood pressure control, and 3) renin-angiotensin system (RAS) blockade. Several studies suggest that the RAS blockade might have blood pressure-independent beneficial effects. RAS blockade leads to proteinuria decrease, attenuation of glomerular hypertrophy and hyperfiltration, along with antiinflamatory and antifibrotic effects. Newer treatments for diabetic nephropathy based on antioxidant and antifibrotic drugs have been described, with encouraging early results.

Keywords: Diabetes mellitus; Renal insufficiency chronic; Proteinuria; Hypertension.