Diabetic nephropathy monitoring -
Identification of patients with microalbuminuria allows for timely initiation of treatment to prevent disease progression and to reduce the risk of ESRD. Treatment of DKD primarily involves careful management of hyperglycemia and hypertension with use of medications that confer specific renal benefit.
Attention should also be paid to other potentially modifiable risk factors Table 1 7 , 8. No large trials have specifically evaluated ideal glycemic targets to prevent DKD, but multiple studies have sought to clarify the optimal level of glycemic control to prevent macrovascular e.
A1C measurements in patients with chronic kidney disease stage 4 or 5 may be falsely low because of shortened red-cell survival time and associated chronic anemia. In these circumstances, routine glucose monitoring may be more accurate for testing and treatment planning.
Hyperglycemia should be managed with a multifactorial approach, including weight loss, exercise, diet modification, and medication. Lifestyle changes and metformin remain the first-line therapy for patients with diabetes.
Secondary data analyses of intermediate renal outcomes in large trials suggest that medications from multiple drug classes may help reduce progression to DKD independent of their glucose-lowering mechanisms Table 5. Blood pressure BP control is critical to prevent and slow the progression of DKD.
BP should be monitored at every routine clinical visit. There is some variation in guideline recommendations for target BP for patients with diabetes and DKD Table 6 32 — Several large studies have attempted to identify the safest BP thresholds, but differences in study design, enrollment criteria, and treatment duration complicate development of a clear, single goal.
To reduce rates of microvascular disease including DKD , systolic BP should be maintained at less than mm Hg, and diastolic BP should be maintained at less than 90 mm Hg.
Initial treatment of hypertension in patients with diabetes should involve lifestyle management. This includes dietary sodium restriction less than 2, mg per day , weight loss if overweight or obese, increased physical activity, and moderation of alcohol intake.
Angiotensin-converting enzyme ACE inhibitors and angiotensin receptor blockers ARBs delay and reduce the progression of DKD. Aldosterone antagonists have therapeutic benefit in combination with ACE inhibitors or ARBs, but the risk of hyperkalemia is high; therefore, they must be prescribed with careful monitoring.
DKD alters lipid metabolism, leading to increased low-density lipoprotein—cholesterol complex and increasing risk of poor outcomes attributable to atherosclerotic cardiovascular disease.
Whereas statin therapy does not significantly alter the progression of DKD, it reduces cardiac events and mortality in patients with nondialysis-dependent renal disease with or without diabetes.
Atorvastatin Lipitor doses do not need to be adjusted. Trials evaluating statin use in patients on hemodialysis have had mixed results, with lower degrees of relative benefit.
Dietary modification has the potential for preventing progression of DKD; however, the evidence for specific interventions is mixed. The American Diabetes Association recommends a protein-restricted diet 0.
These diets include whole-grain carbohydrates, fiber, fresh fruits and vegetables, omega-3 and omega-9 fats, and less than 2, mg per day of sodium. Foods that are high in sugar, saturated fats, and processed carbohydrates should be avoided. The evaluation and treatment of DKD in children and adolescents with types 1 and 2 diabetes are guided by limited evidence.
DKD develops much more rapidly in patients with type 2 diabetes than with type 1. Endocrinology and nephrology consultation should be considered early to help with disease management and prevention of complications in younger patients with DKD.
Reproductive education and preconception counseling are critical for all women of childbearing age who have diabetes, but limited data guide management of DKD specifically. Many medications including ACE inhibitors and ARBs are contraindicated in pregnancy; therefore, these should be avoided in women considering pregnancy.
This article updates previous articles on this topic by Roett, Liegl, and Jabbarpour 53 ; and Thorp. Data Sources: A PubMed search was completed in Clinical Queries using the key term diabetic kidney disease, in combination with the terms diagnosis, treatment, and prevention.
The search included meta-analyses, randomized controlled trials, clinical trials, and reviews, with particular attention to recently published manuscripts.
We also searched the Agency for Healthcare Research and Quality evidence reports, the Cochrane database, Essential Evidence Plus, and the National Guideline Clearinghouse database.
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Treatments and Therapies. Chronic Kidney Disease Nephropathy American Diabetes Association Kidney-Pancreas Transplant National Kidney Foundation. Living With. Emergency Meal Planning for Diabetics National Kidney Foundation.
Albuminuria National Kidney Foundation Glomerular Diseases National Institute of Diabetes and Digestive and Kidney Diseases Nephrotic Syndrome in Adults National Institute of Diabetes and Digestive and Kidney Diseases.
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Reference Desk. Your Kidneys and How They Work National Institute of Diabetes and Digestive and Kidney Diseases Also in Spanish. Find an Expert. American Diabetes Association National Institute of Diabetes and Digestive and Kidney Diseases National Kidney Foundation NIDDK Information Clearinghouses and Health Information Center National Institute of Diabetes and Digestive and Kidney Diseases.
Patient Handouts. Diabetes and kidney disease Medical Encyclopedia Also in Spanish Microalbuminuria test Medical Encyclopedia Also in Spanish Urine protein dipstick test Medical Encyclopedia Also in Spanish.
During a monitorjng biopsy, Diabettic health care professional uses a needle to remove Mouthwash Antioxidant supplements for eye health monitorng of kidney monitorin for lab testing. The biopsy needle Diabetic nephropathy monitoring put through the skin to the kidney. The procedure often uses an imaging device, such as an ultrasound transducer, to guide the needle. Diabetic nephropathy usually is diagnosed during the regular testing that's part of managing diabetes. Get tested every year if you have type 2 diabetes or have had type 1 diabetes for more than five years. Nephropaathy Disclosures. Please read the Disclaimer monitorinf the end of this page. See "Definition nephropatby staging Diabeticc chronic Diabetic nephropathy monitoring disease in adults", section moniroring 'Definition of CKD'. Classification and staging of CKD is based upon GFR and albuminuria table 2 and figure 1. These categories and stages apply to all causes of CKD, including diabetic kidney disease DKD. Most guidelines recommend estimation of GFR and albuminuria at least annually in people with diabetes to detect the development of DKD. See "Diabetic kidney disease: Manifestations, evaluation, and diagnosis", section on 'Manifestations and case detection'.
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