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..........




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.

Thanks Dr Kute Ankush


Very informative

Informative and well presented. Thank you for the hard work. 👍

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

Medicines which can't be given In Diabetic nephropathy when GFR > 60 ml /mt ACE ARB Spiranolactone are contraindicated CCB Beta blockers are used if Diabetic Nephropathy is associated with HTN Not all Diabetic nephropathy hae HTN

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

Thanx dr Pramanick Debasish

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