[Early detection and control of risk factors in diabetic nephropathy]. / Detección precoz y control de factores de riesgo de la nefropatía diabética.

Diabetic nephropathy is an important complication of diabetes. Established nephropathy is preceded by a long silent phase of incipient nephropathy characterized by a subclinical increase in albumin excretion know as microalbuminuria (30-300 mg/d). There is evidence that the progression of nephropathy and its associated mortality can be ameliorated by a number of interventions if started at a nearly stage: glycaemic control, that should be optimized as far as possible, and hypertension control. Angiotensin-converting enzyme (ACE) inhibitors are promoted as first-line agent for treating hypertension in diabetic patients; as well as their systemic hypotensive action, these drugs may have an additional beneficial effect in reducing intraglomerular pressure.

Refeeding syndrome.

Refeeding syndrome is a complex syndrome that occurs as a result of reintroducing nutrition (oral, enteral or parenteral) to patients who are starved or malnourished. Patients can develop fluid-balance abnormalities, electrolyte disorders (hypophosphataemia, hypokalaemia and hypomagnesaemia), abnormal glucose metabolism and certain vitamin deficiencies. Refeeding syndrome encompasses abnormalities affecting multiple organ systems, including neurological, pulmonary, cardiac, neuromuscular and haematological functions. Pathogenic mechanisms involved in the refeeding syndrome and clinical manifestations have been reviewed. We provide suggestions for the prevention and treatment of refeeding syndrome. The most important steps are to identify patients at risk, reintroduce nutrition cautiously and correct electrolyte and vitamin deficiencies properly.