Diabetic nephropathy: can the natural history be modified? Those diabetic patients who progress to advanced kidney disease constitute a subpopulation that is particularly vulnerable to the angiotoxic effects of the insulin-dependent disorder. Until the predisposing factors are identified, the most effective way to arrest renal deterioration is by controlling those currently recognized risk factors that accelerate the glomerulopathy. Treatments that normalize blood pressure, reduce dietary protein intake, and control hyperglycemia have been shown to retard the progression of diabetic nephropathy. 