Diabetic Nephropathy (cont.)
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Diabetic nephropathy is treated with medicines that lower blood pressure and protect the kidneys. These medicines may reverse kidney damage and are started as soon as any amount of protein is found in the urine (microalbuminuria). The use of these medicines before nephropathy occurs may also help prevent nephropathy in people who have normal blood pressure.
If you have high blood pressure, two or more medicines may be needed to lower your blood pressure enough to protect the kidneys. Medicines are added one at a time as needed. The American Diabetes Association recommends a target blood pressure of less than 130/80 millimeters of mercury (mm Hg).1 The level recommended by other groups may vary. Talk with your doctor about what your target blood pressure level should be. For more information on blood pressure medicines, see the topic High Blood Pressure (Hypertension).
It is also important to keep your blood sugar within your target range. Maintaining blood sugar levels within your target range prevents damage to the small blood vessels in the kidneys.
Limiting the amount of salt in your diet can help keep your high blood pressure from getting worse. You may also want to restrict the amount of protein in your diet. If diabetes has affected your kidneys, limiting how much protein you eat may help you preserve kidney function. Talk to your doctor or dietitian about how much protein is best for you.
People who have diabetes are 2 to 4 times more likely than people who don't have diabetes to die of heart and blood vessel diseases. Eating a low-fat diet can help prevent heart attack, stroke, and other large blood vessel disease (macrovascular disease).3
Medicines that are used to treat diabetic nephropathy are also used to control blood pressure. If you have a very small amount of protein in your urine, these medicines may reverse the kidney damage. Medicines used for initial treatment of diabetic nephropathy include:
If you also have high blood pressure, two or more medicines may be needed to lower your blood pressure enough to protect your kidneys. Medicines are added one at a time as needed. The American Diabetes Association recommends a target blood pressure of less than 130/80 millimeters of mercury (mm Hg).1
If you take other medicines, avoid ones that damage or stress the kidneys, especially nonsteroidal anti-inflammatory drugs (NSAIDs).
It is also important to keep your blood sugar within a target range to prevent damage to the small blood vessels in the kidneys. The American Diabetes Association recommends that you keep your blood sugar levels at:1
As diabetic nephropathy progresses, blood pressure usually rises, making it necessary to add more medicine to control blood pressure and keep it less than 130/80 mm Hg.
Your doctor may advise you to take the following medicines that lower blood pressure. You may need to take different combinations of these medicines to best control your blood pressure. By lowering your blood pressure, you may reduce your risk of kidney damage. Medicines include:
Continue to avoid other medicines that may damage or stress the kidneys, especially nonsteroidal anti-inflammatory drugs (NSAIDs). And it is still important to keep your blood sugar within your target range, limit salt in your diet, restrict the amount of protein you eat, keep your cholesterol at a healthy level, eat a low-fat diet, get regular exercise, and not smoke.
Treatment if the condition gets worse
If damage to the blood vessels in the kidneys continues, kidney failure eventually develops. When that occurs, it is likely that you will need dialysis treatment (renal replacement therapy)—an artificial method of filtering the blood—or a kidney transplant to survive. For more information, see the topic Chronic Kidney Disease.
What to think about
Diabetic nephropathy can get worse during pregnancy and can affect the growth and development of the fetus. If your nephropathy is not severe, your kidney function may return to its prepregnancy level after the baby is born. If you have severe nephropathy, pregnancy may lead to permanent worsening of your kidney function.4
If you have nephropathy and are pregnant or are planning to become pregnant, talk with your doctor about which medicines you can take. You may not be able to take some medicines (for example, angiotensin-converting enzyme [ACE] inhibitors, such as captopril, lisinopril, ramipril, or enalapril) during pregnancy, because they may harm your developing baby.
Prevention is the best way to avoid kidney damage from diabetic nephropathy.
If you already have diabetic nephropathy, you may be able to slow the progression of kidney damage by:
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