Early screening of the kidney involvement detected by the presence of microalbuminuria is essential for all patients with diabetes.
As this is the stage where aggressive intervention can delay and possibly halt the progression to the next stages of diabetic nephropathy (DN) and chronic renal failure.
The disease progression can be slowed down by taking the following measures. Strict control of blood sugar. It is very important to protect the kidney function. Intensive blood sugar regulation requires frequent monitoring and commitment.
Strict control of blood pressure. The optimum blood pressure is 130/80 mmHg. The best group of drugs not only to control the blood pressure, but also to decrease the proteins in the urine is “Angiotensin Converting Enzyme Inhibitors” (ACEI).
This group of drugs not only reduces the systemic blood pressure, but also reduces blood pressure inside the Glomeruli and reduces the proteinuria. As we know, the higher the degree of proteinuria, the more rapid will be the deterioration in renal functions and earlier will be the renal failure, so lowering the blood pressure and proteinuria by ACEI, can delay the onset of the renal failure and even at early stages can reverse the disease process.
Some times patients cannot tolerate this group of medicine and develop sever cough. Now another newer group of medicines is available which have similar properties like that of ACEI but cause cough to a lesser extent. This group of medicine is called as Angiotensin Receptor Blockers (ARB). Both ACEI and ARB cause a high serum potassium level in patient with advance renal failure.
This high potassium level may have very dangerous effects upon the heart, so both types of these drugs should be used very carefully and blood potassium level should be monitored regularly in patients with renal failure.
Avoidance of drugs like pain killers which can damage the kidney Avoidance of smoking. Early diagnosis and treatment of urinary tract infection, as it aggravates the kidney failure Decrease in protein intake also decreases the amount of protein in the urine and slows down the progression of kidney disease.
But overemphasis to this may cause malnutrition. The optimum protein intake in a patient with diabetic nephropathy is 0.6-0.8gm/kg/day.