Materiały źródłowe

• #1 Diabetic Nephropathy (Nursing) – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK568691/

  Diabetic kidney disease (DKD) is the leading cause of end-stage kidney disease (ESKD) in developed countries, including the United States. […] Reliable tests for diagnosis and monitoring include urine albuminuria and the estimated GFR (eGFR). Optimizing glycemia and reasonable blood pressure control are pivotal in halting the progression of DKD. […] Diabetic nephropathy is diagnosed by persistent albuminuria on two or more occasions, separated at least by three months on early morning urine samples. Persistent albuminuria is greater than 300 mg over 24 hours or greater than 200 micrograms per minute. […] Treatment of diabetic nephropathy targets four areas: cardiovascular risk reduction, glycemic control, control of blood pressure, and inhibition of the renin-angiotensin system (RAS).

• #1 Diabetic Nephropathy (Nursing) – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK568691/

  Studies have shown the benefit of ARBs (angiotensin receptor blockers) in delaying the progression of kidney disease. […] While RAS blockade is crucial to prevent the development of diabetic nephropathy, multiple studies show that early therapy in patients with T1DM is ineffective in preventing the development of microalbuminuria. […] The nurse should educate the patient on the importance of glucose control and a healthy diet, whereas the pharmacist should educate the patient on medication compliance. […] Evidence shows that working in an interprofessional team with open communication offers patients the best outcomes. […] Diabetic nephropathy is a serious disorder with life long repercussions and a high mortality rate. There is no cure for the disorder, and all treatments have limitations. The key today is to prevent nephropathy from developing.

• #2 Diabetic Nephropathy – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK534200/

  Diabetic nephropathy is the leading cause of end-stage renal disease in developed countries, including the United States. […] Staying informed about these latest developments is crucial for providing optimal care to patients with diabetes and kidney disease. […] Early detection and treatment are critical to delaying progression. […] Management emphasizes cardiovascular risk reduction, glycemic and blood pressure control, and renin-angiotensin system inhibition. […] This activity also underscores the critical role of the interprofessional healthcare team in optimizing care through coordinated management strategies. […] The management of diabetic nephropathy focuses on 4 key areas, including cardiovascular risk reduction, glycemic control, blood pressure (BP) control, and inhibition of the renin-angiotensin system (RAS).

• #2 Diabetic Nephropathy – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK534200/

  The KDIGO guidelines recommend a BP target of less than 120/80 mm Hg for individuals with diabetes, allowing for individualization based on patient-specific factors. […] The use of ACEIs or ARBs in cases of albuminuria without hypertension remains insufficiently studied and should be considered on an individual basis. […] The Diabetes Control and Complications Trial (DCCT) showed comparable results in T1D patients. […] The long-term benefits of early glucose-lowering therapy, particularly when HbA1c is kept below 6.5% during the first year of diagnosis, have been referred to as the „legacy effect” or „metabolic memory.” […] The care of patients with diabetic nephropathy involves a multidisciplinary healthcare team, including internal medicine specialists, hospitalists, endocrinologists, nephrologists, cardiologists, and pathologists. […] Patient-centered care requires a collaborative approach, with contributions from physicians, advanced practice providers, nurses, pharmacists, and other healthcare professionals.

• #3 Management of diabetes mellitus in patients with chronic kidney disease | Cardiovascular Diabetology – Endocrinology Reports | Full Text

  https://clindiabetesendo.biomedcentral.com/articles/10.1186/s40842-015-0001-9

  Glycemic control is essential to delay or prevent the onset of diabetic kidney disease. […] Diabetic nephropathy affects approximately 2040 % of individuals who have diabetes, making it one of the most common complications related to diabetes. […] Screening for diabetic nephropathy along with early intervention is fundamental to delaying its progression in conjunction with providing proper glycemic control. […] Knowledge regarding the prevention and management of diabetic nephropathy, along with other aspects of diabetes care, is part of the comprehensive care of any patient with diabetes. […] Patients with diabetes should be screened on an annual basis for nephropathy. […] Diabetic nephropathy can be detected by the measurement of urine albumin or serum creatinine, and both tests should be performed at minimum annually.

• #3 Management of diabetes mellitus in patients with chronic kidney disease | Cardiovascular Diabetology – Endocrinology Reports | Full Text

  https://clindiabetesendo.biomedcentral.com/articles/10.1186/s40842-015-0001-9

  The first stage of nephropathy is usually the onset of elevated urine albumin which predicts the development of CKD and a gradual decline in glomerular filtration rate (GFR). […] It is therefore important that individuals have both blood and urine screening tests performed. […] Increased albumin excretion is not only a marker for early diabetic kidney disease but also for increased risk for macrovascular disease. […] Referral to a nephrologist should be utilized to establish the cause of nephropathy when this is uncertain. […] Glycemic control is essential to delay the onset of complications from diabetes, and it can be challenging for even the most experienced physician. […] Blood sugar control in those with CKD adds another level of complexity. […] The glycemic target needs to be individualized for each patient, acknowledging that our ability to interpret the data can be altered in the setting of kidney disease.

• #4 The Epidemiology of Diabetic Kidney Disease

  https://www.mdpi.com/2673-8236/2/3/38

  Diabetic kidney disease (DKD) is a frequent long-term complication of diabetes. Globally, DKD is the leading cause of chronic kidney disease (CKD) and end-stage kidney disease (ESKD), accounting for 50% of cases. Typically, DKD is defined by the presence of chronic kidney disease (CKD) characterized by persistently (at least 3 months) elevated urinary albumin excretion (albumin-to-creatine ratio [ACR] ≥ 30 mg/g) and/or low estimated glomerular filtration rate (eGFR < 60 mL/min/1.73 m²) in a person with diabetes. The risk of adverse outcomes, including death and ESKD, increases with decreasing GFR and increasing albuminuria. Individuals with a GFR below 30 mL/min/1.73 m² (i.e., CKD stage 4–5) are at especially high risk across all albuminuria categories. [...] Diabetic kidney disease develops in nearly half of patients with T2DM and one-third of those with T1DM during their lifetime. It is one of the most frequent, burdensome, and expensive long-term complications of diabetes. About 20% of adults with T2DM will develop an eGFR < 60 mL/min/1.73 m², and between 30–50% will have elevated urinary albumin excretion.

• #5 Diagnosis, Treatment Goals, and Management of Diabetic Kidney Disease in the Elderly | Consultant360

  https://www.consultant360.com/articles/diagnosis-treatment-goals-and-management-diabetic-kidney-disease-elderly

  Chronic kidney disease (CKD) affects an estimated 13% of the population, and its prevalence is increasing, largely because of the increased prevalence of several known CKD risk factors, including diabetes mellitus (DM), hypertension, and obesity. The leading cause of CKD is diabetic kidney disease (DKD), a clinical diagnosis generally defined as an elevated urinary albumin excretion rate in a person with DM in the absence of other causes of CKD. It is estimated that 20% to 40% of patients with DM will develop DKD. Like all forms of CKD, DKD not only puts patients at risk for developing end-stage renal disease (ESRD), but it is also an independent risk factor for cardiovascular events and death. Therefore, it is essential that clinicians treating the older patient understand how to appropriately screen patients for DKD so that they may implement an appropriate treatment strategy that is focused not only on slowing the progression of renal disease, but also on reducing cardiovascular risk.

• #5 Diagnosis, Treatment Goals, and Management of Diabetic Kidney Disease in the Elderly | Consultant360

  https://www.consultant360.com/articles/diagnosis-treatment-goals-and-management-diabetic-kidney-disease-elderly

  Current guidelines recommend screening patients with diabetes for DKD using measurements of kidney damage (albuminuria) and function (eGFR) beginning 5 years after the diagnosis of type 1 DM or at the time of diagnosis of type 2 DM, and then annually thereafter. Microalbuminuria, a marker of early diabetic nephropathy, will not be detected through routine urine dipstick measurements and therefore should be evaluated using a spot UACR. […] In patients with DKD, progression to ESRD closely correlates with the degree of proteinuria, affecting less than 10% of patients with less than 1 gram of proteinuria per day as compared with nearly 3 times that in patients with 2 to 4 grams of proteinuria per day. Thus, one of the main treatment strategies for DKD is to decrease albuminuria through inhibition of the renin-angiotensin-aldosterone system (RAAS). The RAAS is an integral part of DKD progression, secondary to DKD’s effect on the development of systemic and glomerular hypertension, increased glomerular capillary permeability, and local inflammation within the kidneys.

• #6 Diabetic nephropathy (kidney disease) – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diabetic-nephropathy/symptoms-causes/syc-20354556

  Diabetic nephropathy happens when diabetes damages blood vessels and other cells in the kidneys. […] Over time, diabetes that isn’t well controlled can damage blood vessels in the kidneys that filter waste from the blood. […] This can lead to kidney damage and cause high blood pressure. […] High blood pressure can cause more kidney damage by raising the pressure in the filtering system of the kidneys. […] To lower your risk of developing diabetic nephropathy: See your health care team regularly to manage diabetes. […] Keep appointments to check on how well you are managing your diabetes and to check for diabetic nephropathy and other complications. […] With good treatment of diabetes, you can keep your blood sugar levels in the target range as much as possible. […] This may prevent or slow diabetic nephropathy. […] If you have high blood pressure or other conditions that raise your risk of kidney disease, work with your health care professional to control them. […] If you’re a smoker, talk to a member of your health care team about ways to quit.

• #6 Diabetic nephropathy (kidney disease) – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diabetic-nephropathy/symptoms-causes/syc-20354556

  Diabetic nephropathy is a serious complication of type 1 diabetes and type 2 diabetes. It’s also called diabetic kidney disease. […] Diabetic nephropathy affects the kidneys’ usual work of removing waste products and extra fluid from the body. […] The best way to prevent or delay diabetic nephropathy is by living a healthy lifestyle and keeping diabetes and high blood pressure managed. […] Early treatment may prevent this condition or slow it and lower the chance of complications. […] Diabetic kidney disease can lead to kidney failure. This also is called end-stage kidney disease. […] Make an appointment with your health care professional if you have symptoms of kidney disease. […] If you have diabetes, visit your health care professional yearly or as often as you’re told for tests that measure how well your kidneys are working.

• #7 Diabetic nephropathy (kidney disease)

  https://johnsonmemorial.org/jmh-health-information-library-disease/con-20203560

  Diabetic nephropathy happens when diabetes damages blood vessels and other cells in the kidneys. […] Over time, diabetes that isn’t well controlled can damage blood vessels in the kidneys that filter waste from the blood. This can lead to kidney damage and cause high blood pressure. […] If you have diabetes, the following can raise your risk of diabetic nephropathy: Uncontrolled high blood sugar, also called hyperglycemia. Uncontrolled high blood pressure, also called hypertension. […] To lower your risk of developing diabetic nephropathy: See your health care team regularly to manage diabetes. Keep appointments to check on how well you are managing your diabetes and to check for diabetic nephropathy and other complications. […] The first step in treating diabetic nephropathy is to treat and control diabetes and high blood pressure. Treatment includes diet, lifestyle changes, exercise and prescription medicines.

• #8

  https://journals.lww.com/cjasn/fulltext/2017/12000/diabetic_kidney_disease__challenges,_progress,_and.17.aspx

  Diabetic kidney disease develops in approximately 40% of patients who are diabetic and is the leading cause of CKD worldwide. […] The natural history of diabetic kidney disease includes glomerular hyperfiltration, progressive albuminuria, declining GFR, and ultimately, ESRD. […] Despite current therapies, there is large residual risk of diabetic kidney disease onset and progression. […] Therefore, widespread innovation is urgently needed to improve health outcomes for patients with diabetic kidney disease. […] Achieving this goal will require characterization of new biomarkers, designing clinical trials that evaluate clinically pertinent end points, and development of therapeutic agents targeting kidney-specific disease mechanisms (e.g., glomerular hyperfiltration, inflammation, and fibrosis).

• #8

  https://journals.lww.com/cjasn/fulltext/2017/12000/diabetic_kidney_disease__challenges,_progress,_and.17.aspx

  However, combination therapy (an ACE inhibitor and an ARB administered together) increases the risk of serious side effects, primarily hyperkalemia and AKI, and offers no clinical benefits. […] Despite current approaches to management of diabetes and hypertension and use of ACE inhibitors and ARB, there is still large residual risk in DKD. […] Novel agents targeting mechanisms, such as glomerular hyperfiltration, inflammation, and fibrosis, have been a major focus for development of new treatments. […] The consistency of these data across glucagon-like peptide-1 receptor agonists persuasively suggests a class effect of protection from DKD. […] The mechanisms of action may be multifactorial and include glycemic control, weight control, and direct effects on the kidney.

• #9 Diabetic Nephropathy – Symptoms, Causes, Treatment & Prevention PACE Hospitals – Best Hospitals in Hitech City, Hyderabad, India | Near Madhapur, Kukatpally, KPHB, Kondapur, Gachibowli, Jubilee Hills, Banjara HillsPACE Hospitals Contact N

  https://www.pacehospital.com/diabetic-nephropathy-symptoms-causes-prevention-and-treatment

  Diabetic nephropathy (DN), also known as diabetic kidney disease (DKD) is one of the most hazardous diabetic chronic microvascular (involving tiny blood vessels) complications, as well as the leading cause of end-stage renal disease (ESRD). The conventional manifestation of diabetic nephropathy is characterized by hyperfiltration (increased glomerular filtration rate) and albuminuria (presence of albumin in urine) in the early stages, followed by gradual kidney function deterioration. […] Management of metabolic and hemodynamic disturbances is critical for preventing and delaying the progression of diabetic nephropathy. Diabetic kidney disease is a global concern that imposes a large social and economic burden. […] Diabetic nephropathy, commonly known as diabetic kidney disease, is a degenerative kidney disorder that affects people with diabetes. It is distinguished by damage to the small blood vessels of the kidneys, which, if left untreated, can result in diminished kidney function and, finally, renal failure.

• #9 Diabetic Nephropathy – Symptoms, Causes, Treatment & Prevention PACE Hospitals – Best Hospitals in Hitech City, Hyderabad, India | Near Madhapur, Kukatpally, KPHB, Kondapur, Gachibowli, Jubilee Hills, Banjara HillsPACE Hospitals Contact N

  https://www.pacehospital.com/diabetic-nephropathy-symptoms-causes-prevention-and-treatment

  The following medications are used to regulate blood sugar levels in diabetic patients with renal disease: Dipeptidyl peptidase inhibitors, Alpha-glucosidase inhibitors, Sodium-glucose cotransporter 2 (SGLT2) inhibitors, Glucagonlike peptide-1 (GLP-1) receptor agonists or incretin mimetics, Amylin analogues, Non-steroidal selective mineralocorticoid receptor (MR) antagonist. […] Diabetic kidney disease (DKD) can be prevented or slowed down by addressing recognised risk factors along with the preventive strategies such as: Glycaemic control (maintaining optimum blood sugar levels), Blood pressure control, Lipid management, Smoking cessation, Regular monitoring, Lifestyle modifications, Medications, Education and awareness.

• #10 Patient education: Diabetic kidney disease (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/diabetic-kidney-disease-beyond-the-basics/print

  Diabetic kidney disease commonly causes no symptoms until at least 80 percent of your kidneys’ function is lost. To detect diabetic kidney disease, health care providers rely on tests that measure protein (albumin) levels in the urine and blood tests to evaluate the level of kidney function. […] When the kidneys are working normally, they prevent albumin from leaking into the urine, so finding albumin in the urine is a sign that the kidneys are in trouble. […] Having a family history of kidney disease or belonging to certain ethnic groups (eg, African American, Mexican, Pima Indian) can increase your risk of diabetic kidney disease. […] Urine tests are recommended once per year in people with type 1 diabetes, beginning about five years after diagnosis, and in people with type 2 diabetes, starting at the time of diagnosis.

• #10 Patient education: Diabetic kidney disease (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/diabetic-kidney-disease-beyond-the-basics/print

  Most people with type 2 diabetes and kidney disease should be treated with a sodium-glucose cotransporter 2 (SGLT2) inhibitor. […] Changing your lifestyle can have a big impact on the health of your kidneys. […] Keeping blood sugars close to normal can help prevent the long-term complications of diabetes mellitus. […] Many people with diabetes have hypertension (high blood pressure). […] A blood pressure reading below 130/80 is the recommended goal for most people with diabetic kidney disease, especially if you have more than 300 mg of albumin in your urine per day. […] All people with diabetic kidney disease need at least one medication to lower their blood pressure, and in most cases two medications are needed. […] ACE inhibitors and ARBs are particularly useful for people with diabetic kidney disease because they decrease the amount of albumin in the urine and can prevent or slow the progression of diabetes-related kidney disease.

• #10 Patient education: Diabetic kidney disease (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/diabetic-kidney-disease-beyond-the-basics/print

  In addition to the measures described above, some people with type 2 diabetes and kidney disease will get a medication called a sodium-glucose cotransporter 2 (SGLT2) inhibitor. […] After beginning treatment and lifestyle changes to stall kidney disease, you will need to have repeat urine and blood tests to determine if urine albumin levels have improved. […] If you have diabetes and are interested in getting pregnant, it is important to talk with your health care provider well in advance, especially if you have diabetic kidney disease. […] The same measures that are used in the treatment of diabetic kidney disease are also useful in preventing it.

• #11 Chronic Kidney Disease | Diabetes | CDC

  https://www.cdc.gov/diabetes/diabetes-complications/diabetes-and-chronic-kidney-disease.html

  Chronic kidney disease (CKD) is common in people with diabetes. […] If you have diabetes, get your kidneys checked regularly to treat CKD early. […] CKD is common in people with diabetes. Approximately 1 in 3 adults with diabetes has CKD. Both type 1 and type 2 diabetes can cause kidney disease. […] Diabetes can reduce how well kidneys filter waste, leading to chronic kidney disease. […] You can help keep your kidneys healthy by managing your blood sugar, blood pressure, and cholesterol levels. […] If you have prediabetes, taking action to prevent type 2 diabetes is an important step in preventing CKD.

• #12 Diabetic Kidney Disease: Diagnosis, Treatment, and Prevention | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0615/p751.html

  Globally, approximately 20% of the 400 million individuals with diabetes mellitus have diabetic kidney disease (DKD). DKD is associated with higher cardiovascular and all-cause morbidity and mortality, so timely diagnosis and treatment are critical. Screening for early DKD is best done with annual spot urine albumin/creatinine ratio testing, and diagnosis is confirmed by repeated elevation in urinary albumin excretion. Treatment includes management of hyperglycemia, hypertension, hyperlipidemia, and cessation of tobacco use. […] Given the complexity of the disease and the risk of poor outcomes, patients who progress to stage 3 DKD or beyond may benefit from referral to nephrology subspecialists. […] The role of primary care physicians in the management of patients with DKD secondary to type 2 diabetes is reviewed.

• #12 Diabetic Kidney Disease: Diagnosis, Treatment, and Prevention | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0615/p751.html

  Identification of patients with microalbuminuria allows for timely initiation of treatment to prevent disease progression and to reduce the risk of ESRD. Treatment of DKD primarily involves careful management of hyperglycemia and hypertension with use of medications that confer specific renal benefit. […] Blood pressure (BP) control is critical to prevent and slow the progression of DKD. […] Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) delay and reduce the progression of DKD. […] Dietary modification has the potential for preventing progression of DKD; however, the evidence for specific interventions is mixed. The American Diabetes Association recommends a protein-restricted diet (0.8 g per kg per day) in patients with DKD, based on studies that show that this can slow the decline of GFR and progression to ESRD. […] Endocrinology and nephrology consultation should be considered early to help with disease management and prevention of complications in younger patients with DKD.

• #13 Diabetic Nephropathy (Kidney Disease)

  https://livinghealthy.hawaiipacifichealth.org/Conditions/Cancer/Tools/85,P00345

  Diabetic kidney disease (DKD) is kidney disease that is due to diabetes. It is also called diabetic nephropathy. Nephropathy means your kidneys aren’t working normally. […] If kidney disease is found, your healthcare provider will address it as part of your diabetes treatment plan. […] Treatment may include correct diet, exercise, controlling blood sugar levels, and medicine to lower blood pressure. […] Have your urine tested regularly to check for a protein called albumin. Even a small amount of albumin in your urine is a sign of early kidney damage.

• #14 Diabetes Canada | Clinical Practice Guidelines

  https://guidelines.diabetes.ca/cpg/chapter29

  Identification of chronic kidney disease in people with diabetes requires screening for proteinuria, as well as an assessment of serum creatinine converted into an estimated glomerular function rate (eGFR). […] The development and progression of renal damage in diabetes can be reduced and slowed through intensive glycemic control and optimization of blood pressure. Progression of chronic kidney disease in diabetes can also be slowed through the use of medications that disrupt the renin angiotensin aldosterone system. […] The earlier that the signs and symptoms of chronic kidney disease in diabetes are detected, the better, as it will reduce the chance of progression to advanced kidney disease and the need for dialysis or transplant. […] If you are found to have signs of chronic kidney disease, your health-care provider may recommend lifestyle or medication changes to help delay more damage to your kidneys.

• #14 Diabetes Canada | Clinical Practice Guidelines

  https://guidelines.diabetes.ca/cpg/chapter29

  Most people with CKD and diabetes will not require referral to a specialist in renal disease and can be managed in primary care. However, specialist care may be necessary when renal dysfunction is severe, when there are difficulties implementing renal-protective strategies or when there are problems managing the sequelae of renal disease.

• #15 Diabetic Nephropathy (Kidney Disease)

  https://brighamandwomens.staywellsolutionsonline.com/Library/TestsProcedures/Cardiovascular/85,P00345

  Diabetic kidney disease (DKD) is kidney disease that is due to diabetes. It is also called diabetic nephropathy. Nephropathy means your kidneys aren’t working normally. […] Type 1 and type 2 diabetes are the most common causes of kidney disease. […] There are 5 stages of DKD. The final stage is kidney failure (end-stage renal disease or ESRD). Going from 1 stage to the next can take many years. […] High blood sugar linked to diabetes damages the kidney in several different ways. Mainly, it damages the blood vessels that filter the blood to make urine. […] People with diabetes also often develop high blood pressure. This can also damage your kidneys. […] If you have diabetes, its important to be checked regularly for kidney disease. To do this, your healthcare provider will keep track of your blood and urine. Your provider will test your urine to check for the protein called albumin. Normally, urine should not have any albumin. Even a small amount of albumin in your urine is a sign of early kidney damage.

• #16 Diabetic Nephropathy | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/20445

  The management of diabetic nephropathy focuses on 4 key areas, including cardiovascular risk reduction, glycemic control, blood pressure (BP) control, and inhibition of the renin-angiotensin system (RAS). […] Intensive glycemic control is most effective when initiated before the onset of diabetic complications, with reduced efficacy when started later. […] The KDIGO guidelines recommend a BP target of less than 120/80 mm Hg for individuals with diabetes, allowing for individualization based on patient-specific factors. […] The use of ACEIs or ARBs in cases of albuminuria without hypertension remains insufficiently studied and should be considered on an individual basis. […] The KDIGO guidelines and the American Diabetes Association (ADA) suggest using metformin alongside dietary modifications as first-line treatment for T2D patients with CKD and an eGFR greater than 30 mL/min/1.73m2.

• #16 Diabetic Nephropathy | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/20445

  Once ESRD develops with an eGFR of 10 to 15 mL/min/1.73m2, renal replacement therapy may be required. […] The care of patients with diabetic nephropathy involves a multidisciplinary healthcare team, including internal medicine specialists, hospitalists, endocrinologists, nephrologists, cardiologists, and pathologists. […] Effective interprofessional communication fosters a collaborative environment where information is shared, questions are welcomed, and concerns are addressed promptly.

• #17 Diabetic nephropathy: Everything you need to know – Wilmington Health

  https://www.wilmingtonhealth.com/blog/diabetic-nephropathy-everything-you-need-to-know/

  Those with diabetes and hypertension can help reduce risk by managing those conditions. […] Diabetes management includes routine screening for diabetic nephropathy. […] There are several ways to mitigate diabetic nephropathy. […] Control of blood pressure and blood glucose is critical. Hypertension can exacerbate progression, even in mild cases. […] After the kidneys fail, a patient must begin dialysis. […] Your physician can recommend some.

• #18 Diabetic nephropathy – Wikipedia

  https://en.wikipedia.org/wiki/Diabetic_nephropathy

  Patients with diabetes mellitus are at significantly increased risk of cardiovascular disease, which is also an independent risk factor for kidney failure. Therefore, it is important to aggressively manage cardiovascular risk factors in patients with diabetes mellitus and in particular those with diabetic nephropathy. […] Multiple studies have found a positive effect of improved glycemic control on clinical outcomes of patients with diabetic nephropathy. […] Multiple randomized clinical trials have demonstrated a benefit of decreasing systolic blood pressure to 140 mmHg in patients with diabetic nephropathy. […] Inhibition can be achieved with multiple therapies, mainly ACE inhibitors, angiotensin receptor blockers, direct renin inhibitors, and mineralocorticoid antagonists. RAAS inhibition has been proven to be the most effective therapy to slow the progression of diabetic nephropathy in all stages.

• #19 Patient education: Diabetic kidney disease (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/diabetic-kidney-disease-beyond-the-basics

  In rare cases, you can have more serious side effects with ACE inhibitors and ARBs. These include a condition called hyperkalemia, in which too much potassium accumulates in the blood. To monitor for these and other side effects, health care providers sometimes run blood tests soon after starting these drugs. In some people, the medications will need to be stopped. […] SGLT2 inhibitors — In addition to the measures described above, some people with type 2 diabetes and kidney disease will get a medication called a sodium-glucose cotransporter 2 (SGLT2) inhibitor. These medications lower blood sugar by increasing the excretion of sugar in the urine in people with good kidney function; they include canagliflozin, empagliflozin, and dapagliflozin. […] In people with reduced kidney function, they should be used because they reduce the risk of worsening kidney disease and risk of developing heart failure.

• #19 Patient education: Diabetic kidney disease (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/diabetic-kidney-disease-beyond-the-basics

  For these reasons, the most important things you can do to stall kidney disease and protect against other diabetes complications are to: […] • Make healthy lifestyle choices […] • Keep your blood sugar as close to normal as possible […] • Keep your blood pressure below 130/80, if possible […] Most people with type 2 diabetes and kidney disease should be treated with a sodium-glucose cotransporter 2 (SGLT2) inhibitor. If there is still albumin in the urine after treatment with appropriate blood pressure medicines and an SGLT2 inhibitor, then a drug called finerenone should also be used. […] Lifestyle changes — Changing your lifestyle can have a big impact on the health of your kidneys. The following measures are recommended for everyone, but are especially important if you have diabetic kidney disease:

• #19 Patient education: Diabetic kidney disease (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/diabetic-kidney-disease-beyond-the-basics

  • Reduced vision or potential visual loss (due to diabetic retinopathy) […] • Nerve damage (called diabetic neuropathy) […] • Stroke and heart attack (both of which can be fatal) […] DIABETIC KIDNEY DISEASE PREVENTION […] The same measures that are used in the treatment of diabetic kidney disease are also useful in preventing it. That’s true for the lifestyle choices mentioned above, as well as for the tight control of blood sugar levels and blood pressure.

• #19 Patient education: Diabetic kidney disease (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/diabetic-kidney-disease-beyond-the-basics

  • Limit the amount of sodium (salt) you eat to less than 2 grams per day […] • If you smoke, quit smoking […] • Lose weight if you are overweight […] Blood sugar control — Keeping blood sugars close to normal can help prevent the long-term complications of diabetes mellitus. For most people, a target for fasting blood glucose and for blood glucose levels before each meal is 80 to 120 mg/dL; however, these targets may need to be individualized. […] A blood test called A1C is also used to monitor blood sugar levels; the result provides an average of blood sugar levels over the last one to three months. An A1C of 7 percent or less is usually recommended; this corresponds to an average blood glucose of 150 mg/dL. Even small decreases in the A1C lower the risk of diabetes-related complications to some degree.

• #20 Diabetic kidney disease – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/530

  Diabetic kidney disease (DKD) is usually a clinical diagnosis in a patient with long-standing diabetes (10 years) with albuminuria and/or reduced estimated glomerular filtration rate (eGFR) in the absence of signs or symptoms of other primary causes of kidney damage. […] Treatment includes intensive management of hyperglycaemia and treatment of hypertension with ACE inhibitors, angiotensin-II receptor antagonists, or other antihypertensives. […] Sodium-glucose co-transporter-2 (SGLT2) inhibitors are moderately to highly effective at glycaemic control and very effective at reducing proteinuria and slowing the progression of DKD. […] Complications include hypoglycaemia due to intensive treatment of hyperglycaemia, hyperkalaemia as an adverse effect of ACE inhibitors or angiotensin-II receptor antagonists, volume depletion due to osmotic diuresis from glycosuria, and inadequate protein/caloric intake leading to malnutrition.

• #21

  https://www.termedia.pl/Nursing-care-of-a-patient-with-diab-etic-kidney-r-ndisease-a-nursing-process-using-the-International-r-nClassification-for-Nursing-Practice-ICNP-r-nduring-the-COVID-19-pandemic,134,50575,1,1.html

  According to the World Health Organization (WHO), the most common microvascular complication of diabetes is diabetic kidney disease (DKD), which is the leading cause of end-stage renal disease worldwide. Diabetic nephropathy develops in about 30% of patients with type 1 diabetes and in about 40% of patients with type 2 diabetes. Clinically, diabetic kidney disease or diabetic nephropathy is defined by the presence of impaired renal function or elevated urinary albumin excretion, or both. The nursing process is a proposed plan of nursing care that encompasses a persons biological, psychological, and social state. It serves to take purposeful, planned actions that contribute to maintaining or improving the patients health and allows the evaluation of the obtained results. The aim of this study is to present the process of nursing a patient with chronic diabetic kidney disease using ICNP terminology during the COVID-19 pandemic. The study patient had end-stage renal failure in the course of diabetic nephropathy. The patient was diagnosed with type 1 diabetes mellitus and had a history of hypertension. The patient would come overhydrated to undergo dialysis. The patient admitted to not sticking to specific meal times and dietary recommendations, and she reported a weakened appetite and reluctance to eat certain recommended foods. During the interview, gaps in knowledge regarding appropriate health management and medication intake were observed, and information regarding fluid and dietary regimes also needed to be systematised and improved. Thus, therapeutic education on the disease and a dietary, fluid, and medication regimen was conducted. A nurse taking care of a patient with renal disease should treat each patient individually, taking into account the patients response to their health, personal and social situation, and the patients attitude to the necessity of changing their lifestyle habits. The International Classification for Nursing Practice (ICNP) provides a simple, standardized tool that can be used to plan and manage nursing care. Nursing diagnoses are related to, among other things, inadequate knowledge of patients about the disease, non-adherence to treatment, poor self-management, and impaired ability to participate in care planning. An important role of the nurse in the nursing process is educational activities in health promotion and prevention of complications. The use of ICNP terminology made it possible to present a structured nursing process for a patient with diabetic kidney disease. The patient was given appropriate nursing care. Health education was carried out. As a result of the interventions, the patient was successfully motivated to self-monitoring and further treatment, and an improvement in vital parameters was achieved.

• #22

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=uh4626

  Having diabetic kidney disease (diabetic nephropathy) means that for some time you have had high blood sugar, which damages the kidneys. This may have taken you by surprise. Damage to kidneys usually doesn’t cause symptoms early on. […] Your doctor will tell you how you might be able to slow damage to your kidneys. In many cases, prompt and regular treatment can prevent kidney failure. You will need to take medicine. You may need to make changes in your normal routines. To help reduce your chance of kidney failure, keep your blood sugar and blood pressure in your target range. And be sure to take your medicines as prescribed. […] Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

• #22

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=uh4626

  Take your medicines exactly as prescribed. It is very important that you take your insulin or other diabetes medicine as your doctor tells you. […] Check your blood sugar as often as your doctor recommends. […] Do not take ibuprofen, naproxen, or similar medicines, unless your doctor tells you to. These medicines may make kidney problems worse. […] Call your doctor or nurse advice line now or seek immediate medical care if: You have new or worse nausea and vomiting. You have much less urine than normal, or you have no urine. You are feeling confused or cannot think clearly. You have new or more blood in your urine. You have new swelling. You are dizzy or light-headed or feel like you may faint. […] Watch closely for changes in your health, and be sure to contact your doctor or nurse advice line if: You do not get better as expected.

• #23 NCP Format 3 (CKD Chronic Kidney Disease DM Diabetes Mellitus Nephropathy) | PDF | Renal Function | Kidney

  https://www.scribd.com/doc/103852593/NCP-Format-3-CKD-Chronic-Kidney-Disease-DM-Diabetes-Mellitus-Nephropathy

  Patient has chronic kidney disease secondary to diabetes nephropathy. This has resulted in fluid volume excess due to decreased glomerular filtration rate and sodium retention. […] The patient is experiencing ineffective breathing patterns from impending pulmonary congestion caused by fluid retention. Nursing interventions include administering diuretics and oxygen to reduce fluid volume and improve breathing. […] The patient is also at risk for impaired skin integrity from prolonged bed rest and edema. Skin assessments and repositioning are needed to prevent skin breakdown.

• #24 NCP Format 3 CKD Chronic Kidney Disease DM Diabetes Mellitus Nephropathy | PDF | Renal Function | Kidney

  https://www.scribd.com/document/447011059/103852593-NCP-Format-3-CKD-Chronic-Kidney-Disease-DM-Diabetes-Mellitus-Nephropathy

  The patient has chronic kidney disease secondary to diabetes nephropathy, as evidenced by impaired glomerular filtration rate and fluid retention, resulting in ineffective breathing patterns. […] Nursing diagnoses include ineffective breathing pattern related to impending pulmonary congestion from impaired kidney function and fluid retention, as well as fluid volume excess related to decreased glomerular filtration rate and sodium retention. […] The priorities are to establish spontaneous breathing and reduce fluid volume excess through interventions such as oxygen, ventilation assistance, diuretic administration, and monitoring of vital signs and fluid output.

• #25 Continuous nursing intervention & early diabetic nephropathy | DMSO

  https://www.dovepress.com/continuous-nursing-intervention-based-on-network-interactive-in-early–peer-reviewed-fulltext-article-DMSO

  Continuous nursing based on the network interactive platform is a new nursing model that extends the nursing service inside the hospital to the nursing outside the hospital, which is very in line with the current needs of modern nursing. […] The results of this study showed that the blood glucose level of the study group was lower than that of the control group. The renal function index of the study group was significantly improved, that is, the study group was better than the control group. […] Extended nursing based on the network interactive platform can effectively meet the needs of patients with diabetic kidney disease for functional training, diet, medication knowledge and other related diseases, and can enhance the self-management behavior of patients, so as to improve the self-efficacy and self-management behavior.

• #25 Continuous nursing intervention & early diabetic nephropathy | DMSO

  https://www.dovepress.com/continuous-nursing-intervention-based-on-network-interactive-in-early–peer-reviewed-fulltext-article-DMSO

  The continuous nursing intervention of network interactive platform has a significant effect on improving the blood glucose level and self-efficacy nursing of patients with early diabetic kidney disease. The adoption of this nursing model can significantly improve the blood glucose level and renal function level of patients. This resulted in further improvements in the self-efficacy and self-management behavior of the patients.

• #25 Continuous nursing intervention & early diabetic nephropathy | DMSO

  https://www.dovepress.com/continuous-nursing-intervention-based-on-network-interactive-in-early–peer-reviewed-fulltext-article-DMSO

  Objective: To analyze the effect of continuous nursing intervention based on network interactive platform on improving blood glucose level and self-efficacy in patients with early diabetic kidney disease. […] In the nursing of patients with early-onset diabetic kidney disease, the application of continuous nursing based on network interactive platform can effectively reduce the level of inflammatory factors, improve the level of blood glucose and renal function, improve the self-efficacy and self-management behavior of patients, and reduce the occurrence of adverse reactions. It is worthy of promotion and application in nursing. […] The treatment of diabetic kidney disease focuses on lowering blood pressure, lowering glucose, nutritional support, reducing urinary protein exudation, and improving renal function. At the same time of drug treatment, the nursing of diabetic kidney disease is also particularly important.

• #26 Diabetic Nephropathy | Self-management | UK Healthcare

  https://ukhealthcare.uky.edu/barnstable-brown-diabetes-center/diabetes-complications/diabetic-nephropathy/self-management

  You can manage diabetic nephropathy and slow further kidney damage by making these lifestyle changes: […] Avoid salt or sodium in the diet […] Avoid alcohol and tobacco […] Exercise regularly […] Keep your blood sugar under control […] Lose weight or maintain a healthy weight.

• #27 Diabetic nephropathy (kidney disease) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diabetic-nephropathy/diagnosis-treatment/drc-20354562

  Diabetic nephropathy usually is diagnosed during the regular testing that’s part of managing diabetes. […] Our caring team of Mayo Clinic experts can help you with your diabetic nephropathy (kidney disease)-related health concerns. […] The first step in treating diabetic nephropathy is to treat and control diabetes and high blood pressure. […] If you take these medicines, you’ll need regular follow-up testing. The testing is done to see if your kidney disease is stable or getting worse. […] Diet, exercise and self-care are needed to control blood sugar and high blood pressure. […] Make sure all your health care professionals know that you have diabetic nephropathy. […] If you have diabetic nephropathy, these steps may help you cope. […] Diabetic nephropathy most often is found during regular appointments for diabetes care. […] Your health care professional is likely to ask you questions during your appointments, including: Do you understand your treatment plan and know that you can follow it? […] Living with diabetic nephropathy can be stressful, and it may help to talk about your feelings.

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