Trevisan R.,USC Malattie Endocrine |
Dodesini A.R.,USC Malattie Endocrine |
Corsi A.,USC Malattie Endocrine |
Scaranna C.,USC Malattie Endocrine |
Lepore G.,USC Malattie Endocrine
Giornale Italiano di Diabetologia e Metabolismo | Year: 2014
Approximately 40% of diabetic patients are at risk of renal disease during the course of the diabetes. Diabetic nephropathy, involving proteinuria, hypertension and fast decline of renal function, is associated not only with a high risk of end-stage renal disease, but also with increased morbidity and mortality from cardiovascular disease. In the last two decades it has become clear that treatment aimed at reducing proteinuria can slow the progression of renal damage. We started an outpatient scheme based on a multimodal intervention protocol to target proteinuria using combination therapy to inhibit the renin-angiotensin system. The results indicated that a multifactorial intervention can significantly slow the decline of renal function in almost 50% of diabetic patients with clinical proteinuria. Although the EMA has discouraged the use of a combination with a drug inhibiting the renin-angiotensin system because of the risk of adverse events, we still believe that, when applied appropriately, a therapy based on dual blockade of the renin-angiotensin system is the best approach to reduce proteinuria and slow renal disease progression in diabetic patients with overt diabetic nephropathy. © 2014 UTET Periodici Scientifici srl.All rights reserved.