Recommendations: Nephropathy Treatment (1)

Recommendations for the treatment of nephropathy in patients with diabetes1 are summarized in three slides Slide 1 of 3 Reduction of protein intake may improve measures of renal function (urine albumin excretion rate, GFR) (B) To 0.8 –1.0 g/kg body wt per day in those with diabetes, earlier stages of CKD To 0.8 g/kg body wt per day in later stages of CKD In the treatment of the nonpregnant patient with modestly elevated (30-299 mg/day) (C) or higher levels (≥399 mg/day) (A) of urinary albumin excretion, either ACE inhibitors or angiotensin II receptor blockers (ARBs) should be used (A) Intensive diabetes management with the goal of achieving near-normoglycemia has been shown in large prospective randomized studies to delay the onset and progression of increased urinary albumin excretion in patients with type 12 and type 23 diabetes The UKPDS provided strong evidence that control of blood pressure can reduce the development of nephropathy489References American Diabetes Association. Standards of medical care in diabetes—2013. Diabetes Care 2013;36(suppl 1):S34-S35. Reichard P, Nilsson BY, Rosenqvist U. The effect of long-term intensified insulin treatment on the development of microvascular complications of diabetes mellitus. N Engl J Med 1993;329:304-309. UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet 1998;352:854-865. UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 1998;317:703-713.