Diabetic nephropathy Health Article

Treatment

The goals of treatment are to slow the progression of kidney damage and control related complications.

The main treatment, once proteinuria is diagnosed, is keeping blood pressure under control (to levels less than 130/80.) If possible, a type of blood pressure medicine, either angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), should be used. These drugs reduce urine protein levels and slow down the diabetic nephropathy. Many studies have suggested that a combination of these two types of drugs may be best.

Uncontrolled high blood pressure will worsen kidney, eye, and blood vessel damage in the body. Controlling your high blood pressure is the most effective way of slowing kidney damage from diabetic nephropathy. It is also very important to control lipid levels, maintain a healthy weight, and engage in regular physical activity.

Blood glucose levels should be closely monitored and controlled. This may slow the progression of the disease especially in the very early stages. Your can change your diet to help control your blood sugar. See: Diet for people with diabetes

Medications to manage diabetes include hypoglycemic pills and insulin injections. Your blood glucose must be monitored and the dose of insulin adjusted as needed. As kidney failure progresses, less insulin is excreted, so smaller doses may be needed to control glucose levels.

Contrast dyes that contain iodine, such as those used during some imaging tests, are excreted through the kidney. These dyes may worsen kidney function, and should be avoided if possible. If they must be used, fluids should be given through an IV line for several hours before the test. This allows for rapid removal of the dyes from the body.

Commonly used nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen, naproxen, and prescription Cox-2 inhibitors such as celecoxib (Celebrex), may injure the weakened kidney. You should always talk to your health care provider before using any drugs.

Urinary tract and other infections are common and can be treated with appropriate antibiotics.

Dialysis may be necessary once end-stage renal disease develops. At this stage, a kidney transplant must be considered. Another option for type 1 diabetes patients is a combined kidney-pancreas transplant.

Expectations (prognosis)

Once large amounts of protein begin to appear in the urine or the serum creatinine begins to rise, diabetic nephropathy typically continues to slowly worsen.

Complications of chronic kidney failure are more likely to occur earlier, and progress more rapidly, when it is caused by diabetes than other causes. Even after dialysis or transplantation, people with diabetes tend to do worse than those without diabetes.

Complications

Possible complications include:

• Anemia
• Chronic kidney failure (rapidly gets worse)
• Dialysis complications
• End-stage kidney disease
• Hyperkalemia
• Severe hypertension
• Hypoglycemia
• Infections
• Kidney transplant complications
• Peritonitis (if peritoneal dialysis used)

Calling your health care provider

Call your health care provider if your health care provider if you have diabetes and a routine urinalysis shows protein.

Call your health care provider if you develop symptoms of diabetic nephropathy, or if new symptoms develop, including little or no urine output.

Prevention

Blood glucose levels should be controlled as closely as possible in people with diabetes. Controlling blood pressure, cholesterol, and weight is just as important.