Management of Diabetic Nephropathy
Diabetic nephropathy is associated with greatly increased cardiovascular morbidity and mortality. Diabetic patients with microalbuminuria are at high risk for the development of overt nephropathy and cardiovascular complications. Management of the patient with diabetic nephropathy must therefore focus on all cardiovascular risk factors as well as specifically on measures to retard the progression of renal disease. How do you treat patients of DN in your practice..........
Informative
Useful informative and updated insight nicely explained to deal with pts of diabetic NEPHROPATHY ,really a tedious job because of its associated complications affecting every part of body at one time or another time of onset and progress.
Informative
Very informative
Informative and well presented. Thank you for the hard work. ๐
Diabetic nephropathy = we mean MCR / ACR > 30 There are 5 grades Grade 1 only MCR > 30 Grade V is ESRD Drugs that reduce protein leak ACE ARB SPIRANOLACTONE DAPAGLIFLOZIN Diuretics CCB Betaadrenargic blockers = no role to play to decrease proteinuria They can have symptomatic role to Play Edema = diuretic HTN = CCB Beta blockers
Informative update
Management of DN Tedious job to undertake Certainly goals defined are the golden work to achieve Yes slowwing of progression of damage is reducing the proteinurea preventing further damage to glomeruli endothelium Keeping arterioles afferent and efferent free from lipid deposits and atherosclerosis Perfusion intact so eGFR is maintained Electrolytes balancing as glucosuria causes loss of Na and hyponatremia in early stages while in advanced stages it reverse to hypernaterimia and water retention and thus oedema or gen anasarca this increasing cardiac morbidity and mortality as eGFR is drastically poor in these stages ie ESRD Uncontrolled hypertension paramount s the condition hence appropriate antihypertensives like ACE or Arabs are to be selected as they act as RAAS Strict control of diabetes with proper insulin and OHA will help in reducing progression of disease Addition of statins and aspirin will further improve in debilitating disease Goal to delay the dialysis or transplant as late as possible and preventing cardiac events as fall out of CRF
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DIABETIC NEPHROPATHY WELL EXPLAINED NICELY. .UPDATED HELPFUL. INSIGHT
Cases that would interest you
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Diabetic pt. taking regular insulin OD,also h/o HTN, swelling both upper limbs.both lower limbs, and face.urea 60,creatinine 3.pls. suggest
Dr. Satish Kumar0 Like56 Answers - Login to View the image
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Dr. Paresh Chandra Kisku1 Like15 Answers - Login to View the image
a 60 yrs old male patient. brought to the hospital with complaints of SOB since 2 days bp.180/100mmhg bl.urea63mg/DL.sr.creatinine.10.1mg/DL...RBs 180 mg/DL....wbc...17,000...ESR...100..hb%-6.5gms
Dr. Upender Singh3 Likes23 Answers - Login to View the image
70 yrs Male...known htn...and dm....on regular rx...on telmikind 40 h....and gemer 2mg.....last....5 days...c.o...mild dysurea..two vomiting episode.......no swelling on lower limb...otherwise no complains......BP.. 110.70...bsl...pp...248 mgdl......so CBC...kft...done...now.....no complains only..mild dysurea....pt economically poor....so....how to manage..this case....which....antihypertensive....is necessary in this...case...pls...suggest managment. pls....pt not able to do...other blood test.@Dr. Shivraj Agarwal
Dr. Chand Sharwale2 Likes18 Answers - Login to View the image
A 49 years old male businessman by profession *Chief Complaints* He presented with complaints of decreased appetite *History* He was taking Glimestar PM1 for sugar once daily, but he never knew about his high blood pressure *Vitals* BP - 212/110 Pulse - 89/min *Investigations* eGFR - 20 S. Cr - 3.26 HbA1C - 8.3 RBS - 180 *Management* Safest OADs in such patient? I have started him on linagliptin 5mg OD, AND Gliclazide 60mg XR half tablet morning For HTN, I have started him on Cilnidipine 20mg OD morning and bisoprolol 2.5 OD in afternoon Kindly give your valubale suggestions in order to reverse his S.Cr to normal levels??
Dr. Ajeet Pal Singh0 Like12 Answers
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