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Renal failure due to diabetic nephropathy accounts for approximately 28% of all new hemodialysis patients in the United States (1), where an acceptance rate of about 130 per million population (p.m.p.) has been reported.

The distribution of different diseases, considered as mortality and morbidity causes, is a crucial clue to the knowledge of the epidemiological charachteristics of a population. Aim of the present study was to assess the distribution of different causes of death in two cohorts of dialysis patients, affected by diabetic nephropathy or by all other forms of renal diseases and to compare the incidence of the different causes of death in dialysis patients and overall population.

Canrenone is the main active metabolite1 of the diuretic and antihypertensive drugs spironolactone and canrenoate-K, and competes with aldosterone for a common cytosolic receptor in distal and collecting tubules of the nephron.2 In addition it has recently been demonstrated that canrenone in vitro may directly interfere with ouabain-sensitive Na+,K+ pump (Na+,K+ adenosine triphosphatase), acting as a partial agonist at the digitalis receptor site. 3,4 Moreover Garay et al.4 showed that canrenone is able to restimulate in vitro the Na+,K+ pump of human red blood cells (RBC) blocked by high concentrations of ouabain.

Corticosteroids have multiple effects on the movement and functional capabilities of inflammatory or immunologically reactive cells, on various soluble factors, on vascular and tissue responses. There is a different sensitivity of various populations and sub-populations of cells to the corticosteroid modulation. These mechanisms are still under discussion, but the final effects appear to support the use of corticosteroids in certain patients with idiopathic glomerulonephritis (GN).