Diabetic nephropathy medical therapy: Difference between revisions
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** Dilatation of systemic and renal arterioles, increasing [[renal blood flow]]. | ** Dilatation of systemic and renal arterioles, increasing [[renal blood flow]]. | ||
** Rise in [[kinins]] which is also responsible for some of the side effects such as dry cough.[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] | ** Rise in [[kinins]] which is also responsible for some of the side effects such as dry cough.[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] | ||
** [[ACE inhibitors]] and [[ARB's]] slow the progression of renal damage from [[diabetes]] to overt renal failure. It is recommended that all patients with [[type I diabetes mellitus|type I]] and [[type II diabetes mellitus]] with [[microalbuminuria]] on routine urine screening should be on [[ACE inhibitors]]. | |||
* [[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 01:40, 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 glomerular hypertension, proteinuria levels, systemic hypertension and slows the progression of diabetic nephropathy.
Medical Therapy
- Anti-diabetic drugs and injectable insulin analogs should be used to maintain normoglycemia.
- ACE inhibitors and ARB's are the drug of choice for controlling hypertension in diabetic nephropathy. Some advantages include:
- Lowering systemic hypertension.
- Lowering glomerular hypertension.
- Dilatation of systemic and renal arterioles, increasing renal blood flow.
- Rise in kinins which is also responsible for some of the side effects such as dry cough.[2]
- ACE inhibitors and ARB's slow the progression of renal damage from diabetes to overt renal failure. It is recommended that all patients with type I and type II diabetes mellitus with microalbuminuria on routine urine screening should be on ACE inhibitors.
- 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.