The goals of treatment are to keep the kidney disease from getting worse and prevent complications. This involves keeping your blood pressure under control (under 130/80). Controlling high blood pressure is the most effective way of slowing kidney damage from diabetic nephropathy.

Your doctor may prescribe the following medicines to lower your blood pressure and protect your kidneys from damage:

• Angiotensin-converting enzyme (ACE) inhibitors
• Angiotensin receptor blockers (ARBs)

These drugs are recommended as the first choice for treating high blood pressure in persons with diabetes and for those with signs of kidney disease.

It is also very important to control lipid levels, maintain a healthy weight, and engage in regular physical activity.

You should closely monitor your blood sugar levels. Doing so may help slow down kidney damage, especially in the very early stages of the disease. Your can change your diet to help control your blood sugar. See also: Diet for people with diabetes

Your doctor may also prescribe medications to help control your blood sugar. Your dosage of medicine may need to be adjusted from time to time. As kidney failure gets worse, your body removes less insulin, so smaller doses may be needed to control glucose levels.

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

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

Nephropathy is a major cause of sickness and death in persons with diabetes. It is the leading cause of long-term kidney failure and end-stage kidney disease in the United States, and often leads to the need for dialysis or kidney transplantation.

The condition slowly continues to get worse once large amounts of protein begin to appear in the urine or levels of creatinine in the blood begin to rise.

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

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)

Call 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.