Diabetic Nephropathy Guidelines

Updated: Jun 19, 2019
  • Author: Vecihi Batuman, MD, FASN; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Guidelines

Guidelines Summary

The American Diabetes Association’s “Standards of Medical Care in Diabetes-2018” include the following recommendations regarding diabetic kidney disease [50] :

  • Optimize glucose control to reduce the risk or slow the progression of diabetic kidney disease
  • Optimize blood pressure control to reduce the risk or slow the progression of diabetic kidney disease
  • For people with nondialysis-dependent diabetic kidney disease, dietary protein intake should be approximately 0.8 g/kg body weight per day (the recommended daily allowance); for patients on dialysis, higher levels of dietary protein intake should be considered
  • In nonpregnant patients with diabetes and hypertension, either an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB) is recommended for those with a modestly elevated urinary albumin-to-creatinine ratio (30-299 mg/g creatinine) and is strongly recommended for those with a urinary albumin-to-creatinine ratio of 300 mg/g creatinine or above and/or an eGFR below 60 mL/min/1.73 m 2
  • Periodically monitor serum creatinine and potassium levels for the development of increased creatinine or changes in potassium when ACE inhibitors, ARBs, or diuretics are used
  • Continued monitoring of the urinary albumin-to-creatinine ratio in patients with albuminuria treated with an ACE inhibitor or an ARB is reasonable to assess the response to treatment and progression of diabetic kidney disease
  • An ACE inhibitor or an ARB is not recommended for the primary prevention of diabetic kidney disease in patients with diabetes who have normal blood pressure, a normal urinary albumin-to-creatinine ratio (< 30 mg/g creatinine), and a normal eGFR
  • When the eGFR is below 60 mL/min/1.73 m 2, evaluate and manage potential complications of chronic kidney disease
  • Patients should be referred for evaluation for renal replacement treatment if they have an eGFR below 30 mL/min/1.73 m 2
  • Promptly refer to a physician experienced in the care of kidney disease for uncertainty about the etiology of kidney disease, difficult management issues, and rapidly progressing kidney disease