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Shingo SAKAMOTO1, 2), Shigehiro YAMADA1), Yusuke SUZUKI2)1)Department of Internal Medicine, Koshigaya Municipal Hospital, Saitama, Japan2)Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, JapanGakuo KOIZUMI1, 2), Yuichiro MAKITA1, 2), Takahiro YAMANAKA1, 2), Corresponding author: Yuichiro MakitaDepartment of Nephrology, Juntendo University Faculty of Medicine, Tokyo, JapanKoshigaya Municipal Hospital, 10-32, higasikoshigaya, koshigaya-shi, saitama-ken, 343-8577 japanTEL: +81-48-965-2221　E-mail: makitay@juntendo.ac.jp〔Received　Nov. 5, 2020〕〔Accepted　May 11, 2021〕J-STAGE Advance published date: Jul. 2, 2021Copyright © 2021 The Juntendo Medical Society. This is an open access article distributed under the terms of Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original source is properly credited. doi: 10.14789/jmj.JMJ20-OA10　In patients with type 2 diabetes, proteinuria is generally considered to be a major factor in the progression to end-stage kidney disease (ESKD) and cardiovascular events. The exacerbation of proteinuria is mainly associated with high blood glucose, hypertension and dyslipidemia. This study is a single-center retrospective cohort study using a large number of patients with type 2 diabetes to investigate the correlation among proteinuria, blood glucose, blood pressure and renal function based on the standard treatment. Patients with type 2 diabetes (n=739) were divided into three groups according to their HbA1c levels, such as HbA1c < 7% ; Group L, 7%≤ HbA1c < 8% ; Group M, and 8% ≤ HbA1c; Group H. A multiple logistic regression model was used to identify the risk associated with those parameters in type 2 diabetes. There was a significant relationship between the increase of proteinuria and the unsatisfactory control of blood pressure (systolic blood pressure of more than 130 mmHg) in all patients with type 2 diabetes. Under the satisfactory control of blood glucose (HbA1c < 7% ; Group L), the annual change of proteinuria (ΔuACR/year) and renal function (ΔeGFR/year), in the patients with an sBP of less than 130mmHg with or without renin-angiotensin system inhibitor (RASI) were milder than in those patients with an sBP of more than 130 mmHg. Therefore, simultaneous strict control of HbA1c and blood pressure with or without renin-angiotensin system inhibitor (RASI) administration are essential in for maintaining renal function in patients with type 2 diabetes.estimated glomerular filtration rate (eGFR).346Juntendo Medical Journal2021. 67(4), 346-354Original ArticlesChange in Proteinuria and Renal Function in Patients with IntroductionPreventing the increase in proteinuria is a primary treatment objective in patients with diabetic nephropathy1, 17, 20). Persistent proteinuria may make this disease progress to end-stage kidney disease (ESKD).2-3) The exacerbation of proteinuria is associated with high blood glucose (HbA1c), hypertension, obesity, a high-protein diet and other issues.11-14, 18, 24) The effects of renin angiotensin system inhibitors (RASI) {angiotensin II type 1 receptor blockers; ARBs and angioten-Key words: diabetic nephropathy, renin-angiotensin system inhibitor (RASI), urinary albumin creatinine ratio (uACR), sin-converting enzyme inhibitors ; ACEIs} on the progression of proteinuria and control of blood pressure have been widely demonstrated in patients with type 2 diabetic nephropathy.4) Most of international guidelines recommend ARBs or ACEIs were first choice for the treatment of hyper-tensive patients with type 2 diabetes.5) Japanese guidelines also recommend treatment with ARBs or ACEIs to ameliorate proteinuria in normoten-sive patients with type 2 diabetes.6) In this study, we performed a single-center retrospective cohort study using a large number of Type 2 Diabetes Receiving Standard Treatment