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Management of Diabetic Nephropathy

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Primer on Nephrology

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Abstract

Diabetic nephropathy (DN) is the single most common cause of end-stage kidney disease and is a major risk factor for cardiovascular disease. The natural history of DN is of slowly evolving albuminuria, hypertension and declining renal function; therefore, a rapid increase in proteinuria or decline in renal function warrants consideration of a renal biopsy to rule out an alternative diagnosis. Management should be focused towards lifestyle changes, tight glycaemic and blood pressure control and modification of cardiovascular risk factors. The target HbA1c varies depending on renal function, with less tight glycaemic control warranted for those with severely impaired renal function, as the increased risk of hypoglycaemia usually outweighs the potential benefits of tight control. ACE inhibitors or angiotensin receptor antagonists are the preferred first-line antihypertensive agents, specifically in patients who have albuminuria, but the combination of two or more drugs that block the renin-angiotensin-aldosterone system should usually be avoided due to the risk of hyperkalaemia and acute kidney injury. The presence of albuminuria is a risk factor for disease progression; therefore, antihypertensive therapy should aim to reduce proteinuria by >50%. Recently, hypoglycaemic agentsglucagon-like peptide-1 agonists and sodium-glucose co-transporter 2 inhibitors have been shown to convincingly and significantly improve renal and cardiovascular outcomes and are rapidly becoming standard of care alongside RAAS inhibition.

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Authors and Affiliations

  1. Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK

    Bryan Conway & Jane Goddard

  2. Department of Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK

    Alan Jaap & Alan Patrick

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  1. Bryan Conway
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Correspondence to Bryan Conway .

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  1. Department of Renal Medicine, UCL, London, UK

    Mark Harber

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Conway, B., Goddard, J., Jaap, A., Patrick, A. (2022). Management of Diabetic Nephropathy. In: Harber, M. (eds) Primer on Nephrology. Springer, Cham. https://doi.org/10.1007/978-3-030-76419-7_38

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