The History of Prevention and Treatment of Diabetic Nephropathy

In 1976 no treatment of diabetic nephropathy was available, and the median survival time was 5–7 years. In 1982–1983, two Danish investigators independently demonstrated the beneficial renoprotective effect of blood pressure lowering. Ten years later the superior renoprotective effect of ACE inhibition in type 1 diabetes was documented. The estimated median survival time from the onset of diabetic nephropathy increased to more than 21 years. A paradigm shift took place in mid-1990s since the topic for kidney research changed towards type 2 diabetic patients. in 2001 two large randomized controlled trials with angiotensin II receptor blockades demonstrated a beneficial effect on a combined renal endpoint including death. Finally, a breakthrough in cardiorenal protection was described in 2019 with the publication of the SONAR and CREDENCE trials. SONAR used a selective endothelin A receptor antagonist, while a sodium glucose co-transporter 2 inhibitor was used in CREDENCE. In 1969, Keen and colleagues detected elevated urinary albumin excretion (microalbuminuria) applying a sensitive radioimmunoassay in diabetes. Later studies demonstrated that microalbuminuria heralds end-stage kidney disease and fatal and non-fatal cardiovascular events in diabetes. It marks the need for intensified treatment with multifactorial intervention targeting glycemic control, blood pressure including blockade of the renin-angiotensin system, and dyslipidemia. This intervention has been demonstrated to reduce complications and improve prognosis significantly. Thus, screening for and treatment of microalbuminuria has changed diabetes care and patient outcomes.