Management strategies for Diabetic Nephropathy.
Meticulous blood glucose control Regular test for Microalbumin
(Early sign of kidney damage)
Avoid dehydration Restrict salt intake Tight control of hypertension
Cessation of smoking Treat Lipid abnormalities Caution against Reno toxic drugs
Diabetic Nephropathy.
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It refers to kidney (renal) damage, as a long term complication of diabetes, especially in patients with poor control of blood sugar levels. |
Diabetic Nephropathy has various stages of development; passing through
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Incipient stage with no symptoms (diagnosed on demonstration of 'Microalbumin' in urine as a first sign of kidney damage);
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Clinical Nephropathy marked by persistent presence of proteins in urine and hypertension,
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Advanced Nephropathy in which there is additionally a significant deterioration of renal function and generalized swelling in body, to
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End Stage Renal Disease which necessitates renal transplant or dialysis.
Management strategies at various stages of kidney damage differ, How ever there are several common features like:
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Meticulous glycemic (sugar control),
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Tight control of blood pressure, if present;
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Avoidance of dehydration etc.
Management strategies for Microalbuminuria
(Incipient Diabetic Nephropathy Stage).
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Meticulous glycemic (sugar) control. |
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Meticulous control of blood pressure, if present. |
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Avoid dehydration. |
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Avoid urinary tract infection. |
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Use of Drug-ACE inhibitors (ACEIs)-a class of antihypertensive, in normotensive (normal blood pressure) patients : |
Management strategies in Clinical Nephropathy.
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Meticulous glycemic (sugar) control. |
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Tight control of blood pressure, especially in patients below the age of 60 years; initiate therapy if blood pressure more than 130/80, or if the diastolic pressure increases by more than 5 mm of mercury. In any one year; the target blood pressure should be 135/85, if possible, although this needs to be individualised.Older patients should have more leeway. |
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Combinations of ACEIs and Calcium channel blockers (classes of anti hypertensive drugs) may be the drug of choice in diabetics. |
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Cessation of smoking. |
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Salt restriction. |
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Protein restriction (0.4-0.6 mg/kg/day) |
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Treat associated lipid disorders. |
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Check for urinary tract infection. |
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Avoid dehydration. |
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Caution against use of drugs which harm renal function and radiographic dyes; this should always be done in any diabetic, but all the more in patients with clinical nephropathy. |
Management strategies in End Stage Renal Disease.
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Renal replacement therapy (Dialysis and/ or Renal transplant) is the treatment for end stage renal disease (ESRD) |