Diabetic nephropathy

Kimmelstiel-Wilson disease; Diabetic glomerulosclerosis; Diabetic kidney disease

The goals of treatment are to slow the progression of kidney damage and control related complications.

The main treatment, once proteinuria is diagnosed, is keeping blood pressure under control (to levels less than 130/80.) If possible, a type of blood pressure medicine, either angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), should be used. These drugs reduce urine protein levels and slow down the diabetic nephropathy. Many studies have suggested that a combination of these two types of drugs may be best.

Uncontrolled high blood pressure will worsen kidney, eye, and blood vessel damage in the body. Controlling your high blood pressure is the most effective way of slowing kidney damage from diabetic nephropathy. It is also very important to control lipid levels, maintain a healthy weight, and engage in regular physical activity.

Blood glucose levels should be closely monitored and controlled. This may slow the progression of the disease especially in the very early stages. Your can change your diet to help control your blood sugar. See: Diet for people with diabetes

Medications to manage diabetes include hypoglycemic pills and insulin injections. Your blood glucose must be monitored and the dose of insulin adjusted as needed. As kidney failure progresses, less insulin is excreted, so smaller doses may be needed to control glucose levels.

Contrast dyes that contain iodine, such as those used during some imaging tests, are excreted through the kidney. These dyes may worsen kidney function, and should be avoided if possible. If they must be used, fluids should be given through an IV line for several hours before the test. This allows for rapid removal of the dyes from the body.

Commonly used nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen, naproxen, and prescription Cox-2 inhibitors such as celecoxib (Celebrex), may injure the weakened kidney. You should always talk to your health care provider before using any drugs.