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Diabetic Nephropathy
Alternate Names : Diabetic Glomerulosclerosis, Diabetic Kidney Disease, Kimmelstiel-Wilson Disease
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Treatment
The goals of treatment are to slow the progression of kidney damage and control related complications.
The main treatment, once proteinuria is established, is angiotensin converting enzyme (ACE) inhibitors. This class of drugs reduces urine protein levels and slows the progression of diabetic nephropathy. Many studies have shown that related drugs, angiotensin receptor blockers (ARBs), have a similar benefit. In fact, a combination may be best.
Blood-glucose levels should be closely monitored and controlled. This may slow the progression of the disorder, especially in the very early ("microalbuminuria") stages.
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.
The diet may be modified (see diet for diabetics) to help control blood-sugar levels.
High blood pressure should be aggressively treated with antihypertensive medications. 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.
Contrast dyes that contain iodine are excreted through the kidney. They may worsen an already reduced glomerular filtration rate, and should be avoided if possible. If they must be used, fluids should be adequate to allow their rapid excretion.
Commonly used non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen, or Cox-2 inhibitors like Celebrax or Vioxx, may injure the weakened kidney. A physician must always be consulted before using any drugs, but especially these.
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.
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Definition Overview, Causes, & Risk Factors Symptoms & Signs Prevention Diagnosis & Tests Treatment Prognosis Complications Calling Your Health Care Provider
Pictures & Images
Topics that might be of interest to you Diseases & Conditions
Chronic Renal Failure Diabetes Diabetic Retinopathy End-Stage Kidney Disease Hyperkalemia Hypertension Hypoglycemia Peritonitis Retinopathy of Prematurity
Tests & Exams
BUN Creatinine - Serum Creatinine - Urine Dialysis Glucose Test Microalbuminuria Test Protein - Urine Protein Electrophoresis - Urine Renal Biopsy Urinalysis
Surgery & Procedures
Kidney Transplant
Other Topics
Appetite - Decreased Diabetes - Diet Fatigue Foot, Leg, and Ankle Swelling Headache Hiccups Malaise Nausea and Vomiting Urine Output - Decreased
Review Date : 11/1/2003
Reviewed By : Irfan A. Agha, M.D., Department of Medicine, Renal Division, St. Louis University, St. Louis, MO. Review provided by VeriMed Healthcare Network.
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