Diabetic Nephropathy

Prevention

The best way to prevent diabetic nephropathy is to control your blood sugar. In addition, your blood pressure should be monitored frequently, and blood pressure should be kept below a peak level (systolic pressure, the “top” blood pressure number) of 130 millimeters of mercury (mmHg), and kept below a bottom number (diastolic pressure) of 80mmHg. These goal numbers for blood pressure are lower than the numbers that are used for people who do not have diabetes.

Two types of blood pressure medicines protect against kidney damage in ways that go beyond lowering your blood pressure. Any person who has diabetes and who also has high blood pressure should regularly take one of these medications. These medicines come from a group of drugs called angiotensin-converting enzyme inhibitors (ACE inhibitors), including lisinopril (Zestril, Prinivil), enalapril (Vasotec), moexipril (Univasc), benazepril (Lotensin) and others, or from a group of drugs called angiotensin receptor blockers (ARBs), including losartan (Cozaar), valsartan (Diovan) and others.

Avoiding medications that can sometimes have harmful side effects upon the kidneys also can help to prevent kidney disease. If you have severe kidney disease, your doctor may advise you to avoid pain medications in the nonsteroidal anti-inflammatory drug group (NSAID group) such as ibuprofen.

A low-protein diet (10% to 12% or less of total calories) also may slow or halt the progression of kidney disease. If you smoke cigarettes, you should quit.

Treatment

If you have diabetes with high blood pressure, microalbuminuria or blood test evidence of kidney disease, it is important for you to take a medication from the ACE inhibitor or ARB group. These medications slow the progression of kidney disease in people with diabetes, although kidney disease continues to develop gradually. These two medicine groups are closely related, so the drugs usually are not combined with each other.

Reducing the amount of protein in your diet also may be helpful to slow progressing kidney disease.