Diabetic nephropathy medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
The goals of treatment are to slow the progression of kidney damage and control related complications. The main treatment, once proteinuria is established, is [[ACE inhibitor]] drugs, which usually reduces [[proteinuria]] levels and slows the progression of diabetic nephropathy | The goals of treatment are to slow the progression of kidney damage and control related complications. The main treatment, once proteinuria is established, is [[ACE inhibitor]] drugs, which usually reduces [[proteinuria]] levels, [[systemic hypertension]] and slows the progression of diabetic nephropathy. | ||
==Medical Therapy== | ==Medical Therapy== | ||
Several effects of the ACEIs that may contribute to renal protection have been related to the association of rise in kinins which is also responsible for some of the side effects associated with ACEIs therapy such as dry cough. The renal protection effect is related to the antihypertensive effects in normal and hypertensive patients, renal vasodilatation resulting in increased renal blood flow and dilatation of the efferent arterioles. [http://www.ksu.edu.sa/sites/Colleges/Medicine/Lists/Medical%20Subjects/Flat.aspx?RootFolder=http%3a%2f%2fwww%2eksu%2eedu%2esa%2fsites%2fColleges%2fMedicine%2fLists%2fMedical%20Subjects%2fDiabetes%20Mellitus%20and%20Angiotensin%20Converting%20Enzyme%20Inhibitors&FolderCTID=0x01200200CEDE56CEF8D11C46824F2F6116DF88AA] Many studies have shown that related drugs, [[angiotensin receptor blocker]]s (ARBs), have a similar benefit. In fact, a combination may be best. | |||
[[Urinary tract]] and other [[infections]] are common and can be treated with appropriate [[antibiotics]]. | [[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 transplantation]] must be considered. Another option for type 1 diabetes patients is a combined kidney-pancreas transplant. | [[Dialysis]] may be necessary once end-stage renal disease develops. At this stage, a [[kidney transplantation]] must be considered. Another option for type 1 diabetes patients is a combined kidney-pancreas transplant. | ||
Revision as of 00:51, 22 January 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The goals of treatment are to slow the progression of kidney damage and control related complications. The main treatment, once proteinuria is established, is ACE inhibitor drugs, which usually reduces proteinuria levels, systemic hypertension and slows the progression of diabetic nephropathy.
Medical Therapy
Several effects of the ACEIs that may contribute to renal protection have been related to the association of rise in kinins which is also responsible for some of the side effects associated with ACEIs therapy such as dry cough. The renal protection effect is related to the antihypertensive effects in normal and hypertensive patients, renal vasodilatation resulting in increased renal blood flow and dilatation of the efferent arterioles. [2] Many studies have shown that related drugs, angiotensin receptor blockers (ARBs), have a similar benefit. In fact, a combination may be best. 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 transplantation must be considered. Another option for type 1 diabetes patients is a combined kidney-pancreas transplant. C-peptide, a by-product of insulin production, may provide new hope for patients sufering from diabetic nephropathy [1] [2].
Drug interaction
Patients with diabetic nephropathy should avoid taking the following drugs:
- Contrast agents containing iodine
- Commonly used non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen, or COX-2 inhibitors like Celebrex, because they may injure the weakened kidney.
References
- ↑ C-peptide is a bioactive peptide. [Diabetologia. 2007] - PubMed Result
- ↑ Wahren J, Ekberg K, Jörnvall H (2007). "C-peptide is a bioactive peptide". Diabetologia. 50 (3): 503–9. doi:10.1007/s00125-006-0559-y. PMID 17235526.