Diabetic nephropathy--how might we prevent, retard, or cope with it?

Working life for most Australian doctors in adult practice is heavily involved with diabetes and its complications. The development of nephropathy is strongly intertwined with that of retinopathy, neuropathy and vasculopathy, and with reduced life duration and quality. What can we do at the coal-face of medical practice to prevent nephropathy occurring at all, to identify it early if it develops, and to maximally limit its impact after its emergence?This article aims not to add to a literature bulging with comprehensive reviews of diabetic nephropathy, but to concisely summarise a useful evidence based approach to the evolutionary stages of the burgeoning problem of diabetic nephropathy.Until we can effectively prevent diabetes or achieve universal euglycaemia, our clinical focus will be on retarding the onset and progression of diabetic complications. Strategies dove-tail with those offering best cardiovascular protection, and are strongly supported by evidence that best outcomes are achieved when blood pressure targets are met, the renin-angiotensin system is blocked, good glycaemic control is achieved, and smoking is avoided.