Diabetic nephropathy medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The goals of treatment are to slow the progression of kidney damage and control related complications. The main treatment, once proteinuria is established, is ACE inhibitor drugs, which usually reduces glomerular hypertension, proteinuria levels, systemic hypertension and slows the progression of diabetic nephropathy.
Medical Therapy
- Anti-diabetic drugs and injectable insulin analogs should be used to maintain normoglycemia.
- ACE inhibitors and ARB's are the drug of choice for controlling hypertension in diabetic nephropathy. Aggressive treatment of hypertension is found to retard the progression of damage to nephrons secondary to diabetes. Some advantages include:
- Lowering systemic hypertension.
- Lowering glomerular hypertension.
- Dilatation of systemic and renal arterioles, increasing renal blood flow.
- Rise in kinins which is also responsible for some of the side effects such as dry cough.[2]
- ACE inhibitors and ARB's slow the progression of renal damage from diabetes to overt renal failure. It is recommended that all patients with type I and type II diabetes mellitus with microalbuminuria on routine urine screening should be on ACE inhibitors.
- 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 transplantation must be considered. Another option for type 1 diabetes patients is a combined kidney-pancreas transplant, which is the preferred mode of renal replacement therapy in otherwise stable patients..
Drug interaction
Patients with diabetic nephropathy should avoid taking the following drugs:
- Contrast agents containing iodine
- Commonly used non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen, or COX-2 inhibitors like Celebrex, because they may injure the weakened kidney.