The Kidney and Hypertension in Diabetes Mellitus

The sum of clinical problems caused by diabetic renal disease has been steadily increasing since the first edition of The Kidney and Hypertension in Diabetes Mellitus was published in 1988. The years since the first edition appeared have seen a tremendous progress in research activities. Importantly, this also includes improvement in the treatment programs to prevent end-stage renal failure. It has become clear that the diabetic kidney is extremely pressure-sensitive, responding to effective antihypertensive treatment by retarded progression of disease. Some agents may be more beneficial in this respect than others, although the effective blood pressure reduction per se is crucial through-out the stages of diabetic renal disease. However, the prime cause of diabetic renal disease is related to poor metabolic control and it is now documented beyond doubt that good metabolic control is able to postpone or perhaps even prevent the development of renal disease. However, in many individuals we are not able to provide such a quality of control that will prevent complications, and therefore non-glycaemic intervention remains important. Maybe in the future non-glycaemic intervention will become the most important research area in diabetic nephropathy.