Materiały źródłowe

• #1 Comprehensive advancements in the prevention and treatment of diabetic nephropathy: A narrative review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10553077/

  Diabetic nephropathy (DN) is a common and severe complication of diabetes mellitus and is the leading cause of chronic kidney disease (CKD) worldwide. […] The advancement in our understanding of the pathogenesis of diabetic nephropathy has led to the development of new prevention and treatment strategies. […] Recent research has shown that early intervention with renin-angiotensin-aldosterone system (RAAS) inhibitors, such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), can help delay the onset and progression of DN. […] Several studies have also shown the benefits of lifestyle modifications, such as weight loss, exercise, and dietary changes, in preventing and managing DN. […] Intensive glycemic control has also reduced the risk of microvascular complications, including DN, in patients with type 1 and 2 diabetes.

• #2 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). […] 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. […] Multiple antihyperglycemic medications, including sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists, and dipeptidyl-peptidase-4 inhibitors, may help prevent DKD by lowering blood glucose levels and through intrinsic renal protection. […] Blood pressure should be monitored at every clinical visit and maintained at less than 140/90 mm Hg to prevent microvascular changes. […] Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers prevent progression of DKD and may decrease albuminuria.

• #3 Diabetes mellitus and renal failure: Prevention and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4755100/

  Nowadays, diabetes mellitus (DM) and hypertension are considered as the most common causes of end-stage renal disease (ESRD). […] According to the high prevalence of DM among patients with ESRD, there is a huge need to learn more about its prevention and management. […] Control of diabetes and early treatment for the risk factors of diabetes are very important in preventing or delaying nephropathy. Control of hypertension with medications that modulate the renin-angiotensin system (RAS) has been shown to decrease the incidence as well as progression of diabetic kidney disease. […] Therefore, based on the recent scientific evidence, it is recommended that glycemic control be considered as the main therapeutic goal in the treatment of diabetic patients with ESRD, too. […] Monitoring of blood glucose level in patients with ESRD is also important because a significant percentage of dialysis patients may get diabetes after the initiation of dialysis.

• #4 Diabetes Canada | Clinical Practice Guidelines

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

  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. […] Optimal glycemic control established as soon after diagnosis as possible will reduce the risk of development of diabetic kidney disease. The progression of renal damage in diabetes can be slowed through intensive glycemic control. […] Optimal BP control also appears to be important in the prevention and progression of CKD in diabetes, although the results have been less consistent. […] Blockade of the renin angiotensin aldosterone system (RAAS) with either an angiotensin converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB) can reduce the risk of developing CKD in diabetes independent of their effect on BP. This protective effect has been demonstrated in people with diabetes and hypertension, but not in normotensive people with diabetes. Additionally, progression of CKD in diabetes can be slowed through the use of an ACE inhibitor or ARB, independent of their effect on BP. […] To prevent the onset and delay the progression of CKD, people with diabetes should be treated to achieve optimal control of BG and BP.

• #5 Chronic Kidney Disease (Nephropathy) | American Diabetes Association

  https://diabetes.org/about-diabetes/complications/chronic-kidney-disease

  Manage your diabetes and blood pressure well to lower the chance of developing chronic kidney disease. […] Having diabetes puts your kidney health at risk. […] The better a person keeps diabetes and blood pressure well-managed, the lower their chance of getting kidney disease. […] Diabetes-related kidney disease can be prevented by keeping blood glucose in your target range. Research has shown that tight blood glucose management reduces the risk of microalbuminuria by one third. […] Important treatments for kidney disease are management of blood glucose and blood pressure. […] Even a mild rise in blood pressure can quickly make kidney disease worsen. […] Work with your health care team about other medications that may be helpful for you to lower your risk of kidney disease.

• #6 Chronic Kidney Disease (Nephropathy) | American Diabetes Association

  https://diabetes.org/about-diabetes/complications/chronic-kidney-disease

  Manage your diabetes and blood pressure well to lower the chance of developing chronic kidney disease. […] Having diabetes puts your kidney health at risk. […] The better a person keeps diabetes and blood pressure well-managed, the lower their chance of getting kidney disease. […] Diabetes-related kidney disease can be prevented by keeping blood glucose in your target range. Research has shown that tight blood glucose management reduces the risk of microalbuminuria by one third. […] Important treatments for kidney disease are management of blood glucose and blood pressure. […] Even a mild rise in blood pressure can quickly make kidney disease worsen. […] Work with your health care team about other medications that may be helpful for you to lower your risk of kidney disease.

• #7 Guidelines adherence in the prevention and management of chronic kidney disease in patients with diabetes mellitus on the background of recent European recommendations – a registry-based analysis | BMC Nephrology | Full Text

  https://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-021-02394-y

  Tight glucose control, targeting HbA1c7.0% (or 53 mmol/mol), is recommended to decrease microvascular complications in patients with diabetes (recommendation class I, level of evidence A). […] Treatment with sodium-glucose transport protein 2 inhibitors ([SGLT-2i] empagliflozin, canagliflozin, or dapagliflozin) is advised in patients with an eGFR 30 to 90 mL/min/1.73 m2) (recommendation class I, level of evidence B) and glucagon-like peptide-1 receptor agonist ([GLP-1Ras] liraglutide, semaglutide) in patients if eGFR is 30 mL/min/1.73m2 (recommendation class IIa, level of evidence B). […] The guidelines recommend that patients with hypertension and diabetes are treated in an individualized manner, SBP to 130 mmHg and 130 mmHg if tolerated, but not 120 mmHg. […] RAAS blockers (ACEi or ARB) are recommended for the treatment of hypertension in patients with diabetes mellitus, particularly in the presence of microalbuminuria, proteinuria or LVH (recommendation class I, level of evidence A).

• #8 Diabetic Kidney Disease: Goals for Management, Prevention, and Awareness

  https://www.mdpi.com/2673-8392/3/3/83

  Diabetic kidney disease (DKD), which is diagnosed on the basis of reduced glomerular filtration rate (GFR), increased albuminuria, or both, is the leading cause of chronic kidney disease (CKD) and end-stage renal disease (ESRD) worldwide. […] The current clinical preventative strategy for DKD involves (1) intensive glycemic control, (2) treatment of associated co-morbidities (hypertension and hyperlipidemia), and (3) instruction on lifestyle modifications, including smoking cessation, exercise, and dietary habits. […] In an effort to reduce the global burden of DKD, as well as DKD-associated mortality, it is critically important to address the risk factors for DKD in diabetes populations. The primary modifiable risk factors for DKD include uncontrolled glycemic index, hypertension and hyperlipidemia co-morbidities, and lifestyle factors (smoking, poor nutrition, and minimal exercise).

• #9 Diabetic Nephropathy (Kidney Disease)

  https://healthlibrary.chnola.org/YourFamily/Children/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. […] The progression of DKD can be slowed by closely managing diabetes. This includes: Watching your A1C level, Eating a healthy diet, Exercising, Not smoking, Staying at a healthy weight, Getting enough sleep, Limiting alcohol, Taking medicines to lower blood pressure, Taking a statin medicine to improve lipid control. […] Treatment may include correct diet, exercise, controlling blood sugar levels, and medicine to lower blood pressure.

• #10 Diabetic nephropathy – Wikipedia

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

  Diabetic nephropathy, also known as diabetic kidney disease, is the chronic loss of kidney function occurring in those with diabetes mellitus. […] Prevention: Smoking cessation. […] The goals of treatment are to slow the progression of kidney damage and control related complications. Management of diabetic nephropathy currently centers over four main areas: Cardiovascular risk reduction, glycemic control, blood pressure control as well as inhibition of the RAAS system. […] Glycemic control: Multiple studies have found a positive effect of improved glycemic control on clinical outcomes of patients with diabetic nephropathy. […] Blood pressure control: Multiple randomized clinical trials have demonstrated a benefit of decreasing systolic blood pressure to 140 mmHg in patients with diabetic nephropathy.

• #11 Diabetes and kidney disease: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000494.htm

  Kidney disease or kidney damage often occurs over time in people with diabetes. This type of kidney disease is called diabetic nephropathy. […] Kidney damage is more likely if you: Have uncontrolled blood sugar (glucose), Are obese, Have high blood pressure, Have type 1 diabetes that began before you were 20 years old, Have family members who also have diabetes and kidney problems, Smoke, Are African American, Mexican American, or Native American. […] When kidney damage is caught in its early stages, it can be slowed with treatment. Once larger amounts of protein appear in the urine, kidney damage will slowly get worse. […] CONTROL YOUR BLOOD PRESSURE Keeping your blood pressure under control (below 130/80 milliliters of mercury (mm Hg)) is one of the best ways to slow kidney damage.

• #12 Comprehensive advancements in the prevention and treatment of diabetic nephropathy: A narrative review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10553077/

  One of the most significant advances in the prevention of DN is the use of angiotensin-converting enzyme inhibitors (ACEIs) and ARBs. […] In addition, recent studies have suggested that SGLT2 inhibitors, a newer class of antidiabetic medications, may also have renoprotective effects. […] Early detection and screening of DN are also crucial in preventing its progression. […] The primary goal of treatment for DN is to slow the progression of renal disease and prevent or delay the onset of ESRD. […] This can be achieved through strict glycemic control, blood pressure control, and RAAS inhibitors. […] Additionally, lifestyle modifications such as weight loss, dietary changes, and exercise can also be beneficial in managing DN. […] Recent development in the prevention and treatment of DN include the use of SGLT2 inhibitors and GLP-1 receptor agonists.

• #13

  https://journals.lww.com/md-journal/fulltext/2023/10060/comprehensive_advancements_in_the_prevention_and.63.aspx

  Diabetic nephropathy (DN) is a common and severe complication of diabetes mellitus and is the leading cause of chronic kidney disease (CKD) worldwide. […] The advancement in our understanding of the pathogenesis of diabetic nephropathy has led to the development of new prevention and treatment strategies. […] Recent research has shown that early intervention with renin-angiotensin-aldosterone system (RAAS) inhibitors, such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), can help delay the onset and progression of DN. […] Several studies have also shown the benefits of lifestyle modifications, such as weight loss, exercise, and dietary changes, in preventing and managing DN. […] Intensive glycemic control has also reduced the risk of microvascular complications, including DN, in patients with type 1 and 2 diabetes.

• #14 Preventing Diabetic Kidney Disease: 10 Answers to Questions | National Kidney Foundation

  https://www.kidney.org/kidney-topics/preventing-diabetic-kidney-disease-10-answers-to-questions

  Some studies suggest that a group of high blood pressure medicines called ACE inhibitors may help to prevent or delay the progression of diabetic kidney disease. These drugs reduce blood pressure in your body, and they may lower the pressure within the kidney’s filtering apparatus (the glomerulus). They also seem to have beneficial effects that are unrelated to changes in blood pressure.

• #15 Diabetic nephropathy – Wikipedia

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

  RAAS inhibition: 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. […] Some evidence suggests that limiting dietary protein could slow the progression of DN, but further evidence is needed to confirm this benefit.

• #16

  https://journals.lww.com/jasn/fulltext/2006/04002/prevention_and_treatment_of_diabetic_renal_disease.14.aspx

  Diabetic nephropathy (DN) is the leading cause of end-stage renal failure in Western countries and carries an increased risk for cardiovascular mortality. […] Prevention of the onset of microalbuminuria, therefore, could be considered as the primary means of preventing DN. […] The BENEDICT Phase A study showed that DN can be prevented by ACE inhibitor therapy. […] The apparent advantage of ACE inhibitors over other agents includes a protective effect on the kidney against the development of microalbuminuria, which is a major risk factor for cardiovascular events and death in this population. […] Microalbuminuria is an early marker of DN. […] Although treating patients with diabetes by reducing the progression from microalbuminuria to macroalbuminuria may delay renal disease progression (i.e., secondary prevention), prevention of the onset of microalbuminuria could be considered as the primary means of preventing DN.

• #17

  https://journals.lww.com/jasn/fulltext/2006/04002/prevention_and_treatment_of_diabetic_renal_disease.14.aspx

  Preliminary evidence available in hypertensive patients with type 2 diabetes suggests that the incidence of microalbuminuria may be reduced by ACE inhibition therapy. […] The BENEDICT study showed that DN can be prevented by early intervention. […] The renoprotective effect of ACE inhibition did not seem to be enhanced by the addition of an ndCCB. […] These findings suggest that in hypertensive patients with type 2 diabetes and normal renal function, an ACE inhibitor may be the medication of choice for controlling BP.

• #18 Diabetic Kidney Disease: Goals for Management, Prevention, and Awareness

  https://www.mdpi.com/2673-8392/3/3/83

  This entry will review the current preventative approach for DKD, including strict glycemic control, treatment of hypertension and hyperlipidemia, promotion of patient-driven lifestyle modifications, and incorporation of point-of care patient education. […] In summary, individualized dietary and exercise modifications, as well as smoking cessation are all non-invasive, non-pharmacological therapies and should be considered an important factor in DKD prevention and management. […] Patient-centered education on the importance of proper disease management could greatly improve general awareness of DKD and promote proactive intervention in diabetes patients. […] A thorough preventive approach for DKD includes glycemic control, treatment of hypertension and hyperlipidemia co-morbidities, and lifestyle modifications (diet, exercise, and smoking cessation).

• #19 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 kidney disease (DKD) can be prevented or slowed down by addressing recognised risk factors along with the preventive strategies such as: […] Preventing diabetic nephropathy requires maintaining an acceptable levels of glucose in the blood. […] One more crucial step in preventing diabetic nephropathy is blood pressure control. […] To avoid diabetic nephropathy, lipid control is also essential. […] Smoking is one established risk factor for diabetic nephropathy. […] To avoid diabetic nephropathy, kidney function must be regularly monitored. […] Diabetes-related nephropathy can also be avoided by adopting lifestyle changes like consistent exercise, a balanced diet, and weight control. […] Diabetes-related nephropathy is said to be managed with medications such as angiotensin receptor blockers and angiotensin-converting enzyme inhibitors. […] The prevention of diabetic nephropathy is mostly depends on education and awareness.

• #20 Diabetic nephropathy: Symptoms, stages, causes, and treatment

  https://www.medicalnewstoday.com/articles/319686

  Diabetic nephropathy is a long-term kidney disease that can affect people with diabetes. […] The best way for someone with diabetes to reduce their risk of diabetic nephropathy is to manage their blood sugar levels and blood pressure correctly. […] Lifestyle changes that can help with this include: eating a nutritious diet that is high in fiber and low in sugar, processed carbohydrates, and salt, exercising regularly, limiting alcohol intake, avoiding tobacco, checking blood glucose levels regularly, following any treatment plan their doctor suggests, limiting stress where possible. […] Treatment can delay or prevent the progress of diabetic nephropathy. […] Following a treatment plan for diabetes and attending regular health checks can help a person with diabetes control their blood sugar levels, reduce the risk of kidney problems, and find out early if they need to take action.

• #21

  https://journals.lww.com/md-journal/fulltext/2023/10060/comprehensive_advancements_in_the_prevention_and.63.aspx

  Blood pressure control: Controlling blood pressure is another important measure in preventing diabetic nephropathy. […] Lifestyle modifications: Lifestyle modifications such as regular physical activity, healthy eating habits, and weight management can also help prevent diabetic nephropathy. […] Medications: Medications such as angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are recommended for managing diabetic nephropathy. […] Education and awareness are crucial in preventing diabetic nephropathy. […] Overall, recent advances in the prevention and treatment of DN have provided new insights into managing this challenging complication of diabetes.

• #22 What doctors wish patients knew about kidney disease prevention | American Medical Association

  https://www.ama-assn.org/delivering-care/hypertension/what-doctors-wish-patients-knew-about-kidney-disease-prevention

  Another important part of preventing kidney disease is by adopting healthy lifestyles, so eat a healthy diet and exercise regularly, Dr. Correa said, adding that stopping smoking will help not only the lungs, but the kidneys too. […] Additionally, manage your alcohol intake because drinking excessive amounts can cause your blood pressure and cholesterol levels to rise to unhealthy levels, he said.

• #23 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). […] 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. […] Multiple antihyperglycemic medications, including sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists, and dipeptidyl-peptidase-4 inhibitors, may help prevent DKD by lowering blood glucose levels and through intrinsic renal protection. […] Blood pressure should be monitored at every clinical visit and maintained at less than 140/90 mm Hg to prevent microvascular changes. […] Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers prevent progression of DKD and may decrease albuminuria.

• #24 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. […] 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. […] Diabetic nephropathy can be detected by the measurement of urine albumin or serum creatinine, and both tests should be performed at minimum annually; those with abnormal levels should have repeat tests done sooner. […] Increased albumin excretion is not only a marker for early diabetic kidney disease but also for increased risk for macrovascular disease.

• #25 Diabetes and Chronic Kidney Disease: Prevention, Early Recognition, and Treatment | Consultant360

  https://www.consultant360.com/articles/diabetes-and-chronic-kidney-disease-prevention-early-recognition-and-treatment

  Diabetes care presents several challenges for both patient and clinician. But the challenge is significantly increased when it is complicated by chronic kidney disease (CKD). Fortunately, CKD is preventable and, if recognized early disease, progression can be halted. […] Primary care clinicians provide the majority of care for patients with diabetes so they are ideally suited to prevent, recognize, and provide initial treatment for CKD. This can be done by screening for diabetic kidney disease with urine microalbumin, obtaining serum creatinine levels to calculate glomerular filtration rate, closely monitor hemoglobin A1c, blood pressure, lipid levels, and appropriately treat abnormal levels to achieve evidence-based goals. […] The current guidelines from the American Diabetes Association (ADA) recommend the following: Perform an annual test to assess urine albumin excretion in type 2 diabetic patients. Measure serum creatinine at least annually in all adults with diabetes regardless of the degree of urine albumin excretion. The serum creatinine should be used to estimate GFR and stage the level of CKD.

• #26 Diabetes: Medical Attention for Nephropathy

  https://qpp.cms.gov/docs/ecqm-specs/2017/EC_CMS134v5_NQF0062_Diab_Urine/CMS134v5.html

  The percentage of patients 18-75 years of age with diabetes who had a nephropathy screening test or evidence of nephropathy during the measurement period. […] Clinical Recommendation Statement American Diabetes Association (2015): Screening – At least once a year, quantitatively assess urinary albumin (eg, urine albumin-to-creatinine ratio [UACR]) and estimated glomerular filtration rate (eGFR) in patients with type 1 diabetes duration of greater than or equal to 5 years and in all patients with type 2 diabetes. […] Treatment – An angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) is not recommended for the primary prevention of diabetic kidney disease in patients with diabetes who have normal blood pressure and normal UACR (30 mg/g). […] – Continued monitoring of UACR in patients with albuminuria is reasonable to assess progression of diabetic kidney disease.

• #27 Guidelines adherence in the prevention and management of chronic kidney disease in patients with diabetes mellitus on the background of recent European recommendations – a registry-based analysis | BMC Nephrology | Full Text

  https://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-021-02394-y

  This database analysis shows that about every other patient with diabetes is screened for the presence of CKD annually; less than half of patients achieve a target HbA1c of 7.0% (or 53 mmol/mol); recommended use of SGLT-2i and GLP1-RA is well below 10%; hypertension is controlled in about two-thirds of patients with lower rates depending on age and respective SBP thresholds; RAAS blockers are used in about half of the patients. […] It is essential, therefore, that kidney involvement is detected as early as possible. […] The ESC/EASD recommendations to screen patients annually for kidney disease using eGFR and UACR has also been recommended by the 2020 American Diabetes Association (ADA) and the 2013 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline.

• #28 Comprehensive advancements in the prevention and treatment of diabetic nephropathy: A narrative review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10553077/

  One of the most significant advances in the prevention of DN is the use of angiotensin-converting enzyme inhibitors (ACEIs) and ARBs. […] In addition, recent studies have suggested that SGLT2 inhibitors, a newer class of antidiabetic medications, may also have renoprotective effects. […] Early detection and screening of DN are also crucial in preventing its progression. […] The primary goal of treatment for DN is to slow the progression of renal disease and prevent or delay the onset of ESRD. […] This can be achieved through strict glycemic control, blood pressure control, and RAAS inhibitors. […] Additionally, lifestyle modifications such as weight loss, dietary changes, and exercise can also be beneficial in managing DN. […] Recent development in the prevention and treatment of DN include the use of SGLT2 inhibitors and GLP-1 receptor agonists.

• #29

  https://journals.lww.com/md-journal/fulltext/2023/10060/comprehensive_advancements_in_the_prevention_and.63.aspx

  One of the most significant advances in the prevention of DN is the use of angiotensin-converting enzyme inhibitors (ACEIs) and ARBs. […] In addition, recent studies have suggested that SGLT2 inhibitors, a newer class of antidiabetic medications, may also have renoprotective effects. […] Early detection and screening of DN are also crucial in preventing its progression. […] The primary goal of treatment for DN is to slow the progression of renal disease and prevent or delay the onset of ESRD. […] The comprehensive management of DN involves targeting pathological signals, implementing clinical treatments, and adhering to dietary regulations. […] Recent development in the prevention and treatment of DN include the use of SGLT2 inhibitors and GLP-1 receptor agonists. […] Glycemic control: Maintaining reasonable glycemic control is essential in preventing diabetic nephropathy.

• #30 Treatment of Diabetic Kidney Disease: Current and Future

  https://www.e-dmj.org/journal/view.php?doi=10.4093/dmj.2020.0217

  Diabetic kidney disease (DKD) is one of the major complications for diabetic patients and the most significant cause of end-stage kidney disease (ESKD). […] Multi-disciplinary treatments, including blood glucose control, blood pressure and lipid control with renin-angiotensin-aldosterone system (RAS) inhibitors, appropriate weight management, and guidance for diet and smoking cessation, are important. […] Sodium-glucose cotransporter 2 (SGLT2) inhibitors were also added as a new drug of choice for DKD treatment in 2019, as the Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) study showed that SGLT2 inhibitors inhibited DKD progression. […] One of the important factors in DKD development is the phenomenon known as metabolic memory.

• #31 Guidelines adherence in the prevention and management of chronic kidney disease in patients with diabetes mellitus on the background of recent European recommendations – a registry-based analysis | BMC Nephrology | Full Text

  https://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-021-02394-y

  Tight glucose control, targeting HbA1c7.0% (or 53 mmol/mol), is recommended to decrease microvascular complications in patients with diabetes (recommendation class I, level of evidence A). […] Treatment with sodium-glucose transport protein 2 inhibitors ([SGLT-2i] empagliflozin, canagliflozin, or dapagliflozin) is advised in patients with an eGFR 30 to 90 mL/min/1.73 m2) (recommendation class I, level of evidence B) and glucagon-like peptide-1 receptor agonist ([GLP-1Ras] liraglutide, semaglutide) in patients if eGFR is 30 mL/min/1.73m2 (recommendation class IIa, level of evidence B). […] The guidelines recommend that patients with hypertension and diabetes are treated in an individualized manner, SBP to 130 mmHg and 130 mmHg if tolerated, but not 120 mmHg. […] RAAS blockers (ACEi or ARB) are recommended for the treatment of hypertension in patients with diabetes mellitus, particularly in the presence of microalbuminuria, proteinuria or LVH (recommendation class I, level of evidence A).

• #32 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). […] 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. […] Multiple antihyperglycemic medications, including sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists, and dipeptidyl-peptidase-4 inhibitors, may help prevent DKD by lowering blood glucose levels and through intrinsic renal protection. […] Blood pressure should be monitored at every clinical visit and maintained at less than 140/90 mm Hg to prevent microvascular changes. […] Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers prevent progression of DKD and may decrease albuminuria.

• #33 Guidelines adherence in the prevention and management of chronic kidney disease in patients with diabetes mellitus on the background of recent European recommendations – a registry-based analysis | BMC Nephrology | Full Text

  https://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-021-02394-y

  Tight glucose control, targeting HbA1c7.0% (or 53 mmol/mol), is recommended to decrease microvascular complications in patients with diabetes (recommendation class I, level of evidence A). […] Treatment with sodium-glucose transport protein 2 inhibitors ([SGLT-2i] empagliflozin, canagliflozin, or dapagliflozin) is advised in patients with an eGFR 30 to 90 mL/min/1.73 m2) (recommendation class I, level of evidence B) and glucagon-like peptide-1 receptor agonist ([GLP-1Ras] liraglutide, semaglutide) in patients if eGFR is 30 mL/min/1.73m2 (recommendation class IIa, level of evidence B). […] The guidelines recommend that patients with hypertension and diabetes are treated in an individualized manner, SBP to 130 mmHg and 130 mmHg if tolerated, but not 120 mmHg. […] RAAS blockers (ACEi or ARB) are recommended for the treatment of hypertension in patients with diabetes mellitus, particularly in the presence of microalbuminuria, proteinuria or LVH (recommendation class I, level of evidence A).

• #34 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). […] 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. […] Multiple antihyperglycemic medications, including sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists, and dipeptidyl-peptidase-4 inhibitors, may help prevent DKD by lowering blood glucose levels and through intrinsic renal protection. […] Blood pressure should be monitored at every clinical visit and maintained at less than 140/90 mm Hg to prevent microvascular changes. […] Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers prevent progression of DKD and may decrease albuminuria.

• #35 Chronic Kidney Disease in Diabetes – Diabetes Canada

  https://www.diabetes.ca/health-care-providers/clinical-practice-guidelines/chapter-29

  Adults with diabetes and CKD with either hypertension or albuminuria should receive an ACE inhibitor or an ARB to delay progression of CKD. […] People with diabetes on an ACE inhibitor or an ARB should have their serum creatinine and potassium levels checked at baseline and within 1 to 2 weeks of initiation or titration of therapy and during times of acute illness. […] Adults with diabetes and CKD should be given a sick-day medication list that outlines which medications should be held during times of acute illness. […] Combinations of ACE inhibitor, ARB or DRI should not be used in the management of diabetes and CKD. […] In adults with type 2 diabetes with clinical CVD in whom glycemic targets are not achieved with existing antihyperglycemic medication(s) and with an eGFR 30 mL/min/1.73 m2, an SGLT2 inhibitor with proven renal benefit may be considered to reduce the risk of progression of nephropathy.

• #36

  https://link.springer.com/article/10.1007/s11255-005-2394-3

  The rising incidence of type 2 diabetes mellitus and of its complications will make it the most important health care challenge in the first quarter of the 21st Century. Diabetic nephropathy left unchecked will overwhelm the renal resources. Simple methods (proper diet and exercise, prevention of obesity) are successful in preventing type 2 diabetes in the great majority of the persons at risk. […] In patients with established type 2 diabetes, nephropathy can be prevented or greatly delayed by strict metabolic control, strict control of blood pressure using angiotensin-converting enzyme inhibitors and angiotensin receptor blockers as the first line of drugs, tight control of serum lipids using statins as indicated, low protein diet, avoidance of smoking and other nephrotoxic influences, prevention of abnormalities in calcium/phosphorus metabolism, and prevention of renal anemia by the early use of erythropoietin. Current research offers the promise of definitive prevention of both type 2 diabetes and diabetic nephropathy.

• #37 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 kidney disease (DKD) can be prevented or slowed down by addressing recognised risk factors along with the preventive strategies such as: […] Preventing diabetic nephropathy requires maintaining an acceptable levels of glucose in the blood. […] One more crucial step in preventing diabetic nephropathy is blood pressure control. […] To avoid diabetic nephropathy, lipid control is also essential. […] Smoking is one established risk factor for diabetic nephropathy. […] To avoid diabetic nephropathy, kidney function must be regularly monitored. […] Diabetes-related nephropathy can also be avoided by adopting lifestyle changes like consistent exercise, a balanced diet, and weight control. […] Diabetes-related nephropathy is said to be managed with medications such as angiotensin receptor blockers and angiotensin-converting enzyme inhibitors. […] The prevention of diabetic nephropathy is mostly depends on education and awareness.

• #38 Diabetic Nephropathy (Kidney Disease)

  https://healthlibrary.chnola.org/YourFamily/Children/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. […] The progression of DKD can be slowed by closely managing diabetes. This includes: Watching your A1C level, Eating a healthy diet, Exercising, Not smoking, Staying at a healthy weight, Getting enough sleep, Limiting alcohol, Taking medicines to lower blood pressure, Taking a statin medicine to improve lipid control. […] Treatment may include correct diet, exercise, controlling blood sugar levels, and medicine to lower blood pressure.

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

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

  Prevention of diabetes in the general population is the most effective means of minimizing the impact of DKD; understanding risk factors for DKD development can help with early identification and intervention. […] Effectively using screening guidelines, treatment strategies, and subspecialty referral can help prevent progression of DKD. […] Identification of patients with microalbuminuria allows for timely initiation of treatment to prevent disease progression and to reduce the risk of ESRD. […] 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.

• #40 Diabetic nephropathy – Wikipedia

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

  RAAS inhibition: 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. […] Some evidence suggests that limiting dietary protein could slow the progression of DN, but further evidence is needed to confirm this benefit.

• #41 Diabetic Nephropathy – Harvard Health

  https://www.health.harvard.edu/a_to_z/diabetic-nephropathy-a-to-z

  Diabetic nephropathy is kidney disease that is a complication of diabetes. […] The best way to prevent diabetic nephropathy is to control your blood sugar and to keep your blood pressure in the normal range. […] Two types of blood pressure medicines protect against kidney damage in ways that go beyond lowering your blood pressure. […] Avoiding medications that can sometimes have harmful side effects upon the kidneys also can help to prevent kidney disease. […] A low-protein diet (10% to 12% or less of total calories) also may slow or halt the progression of kidney disease.

• #42 Diabetic nephropathy Guide: Causes, Symptoms and Treatment Options

  https://www.drugs.com/health-guide/diabetic-nephropathy.html

  Diabetic nephropathy is kidney disease that is a complication of diabetes. […] The best way to prevent diabetic nephropathy is to control your blood sugar and to keep your blood pressure in the normal range. […] Two types of blood pressure medicines protect against kidney damage in ways that go beyond lowering your blood pressure. […] Avoiding medications that can sometimes have harmful side effects upon the kidneys also can help to prevent kidney disease. […] A low-protein diet (10% to 12% or less of total calories) also may slow or halt the progression of kidney disease. […] If you have diabetes with microalbuminuria or blood test evidence of kidney disease, you can slow the progression of kidney disease by taking a drug called an SGLT2 inhibitor. […] These medications slow the progression of kidney disease in people with diabetes, although kidney disease continues to develop gradually. […] Although kidney failure cannot always be prevented, worsening can be slowed with medications and control of risk factors.

• #43 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. Get tested every year if you have type 2 diabetes or have had type 1 diabetes for more than five years. […] 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. Controlling blood sugar and blood pressure might prevent or delay kidney issues and other complications. […] Diet, exercise and self-care are needed to control blood sugar and high blood pressure. Your diabetes care team can help you with the following goals: […] Talk to your health care team. Make sure all your health care professionals know that you have diabetic nephropathy. They can take steps to protect your kidneys from more damage by not doing medical tests that use contrast dye. These include angiograms and computerized tomography (CT) scans. […] In the future, people with diabetic nephropathy may benefit from treatments being developed using techniques that help the body repair itself, called regenerative medicine. These techniques may help reverse or slow kidney damage.

• #44 Diabetes and kidney disease: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000494.htm

  Kidney disease or kidney damage often occurs over time in people with diabetes. This type of kidney disease is called diabetic nephropathy. […] Kidney damage is more likely if you: Have uncontrolled blood sugar (glucose), Are obese, Have high blood pressure, Have type 1 diabetes that began before you were 20 years old, Have family members who also have diabetes and kidney problems, Smoke, Are African American, Mexican American, or Native American. […] When kidney damage is caught in its early stages, it can be slowed with treatment. Once larger amounts of protein appear in the urine, kidney damage will slowly get worse. […] CONTROL YOUR BLOOD PRESSURE Keeping your blood pressure under control (below 130/80 milliliters of mercury (mm Hg)) is one of the best ways to slow kidney damage.

• #45 Diabetic Nephropathy Treatment & Management: Approach Considerations, Glycemic Control, Management of Hypertension

  https://emedicine.medscape.com/article/238946-treatment

  Efforts should be made to modify and/or treat associated risk factors such as hyperlipidemia, smoking, and hypertension. Specific goals for prevention include the following: Optimal blood glucose control (hemoglobin A1c [HbA1c] 7%), Control of hypertension (BP 120/70 Hg), Avoidance of potentially nephrotoxic substances such as nonsteroidal anti-inflammatory medications and aminoglycosides, Early detection and optimal management of diabetes, especially in the setting of family history of diabetes. […] Regular outpatient follow-up is key in managing diabetic nephropathy successfully. Regular annual urinalysis is recommended for screening for microalbuminuria. Ensuring optimal glucose control, optimizing blood pressure, and screening for other associated complications of diabetes (eg, retinopathy, diabetic foot, cardiovascular disease) are also crucial.

• #46 Diabetes and kidney disease Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/diabetes-and-kidney-disease

  CONTROL YOUR BLOOD SUGAR LEVEL. You can also slow kidney damage by controlling your blood sugar level through: Eating healthy foods, Getting regular exercise, Taking oral or injectable medicines as instructed by your provider, Some diabetes medicines are known to prevent the progression of diabetic nephropathy better than other medicines. […] OTHER WAYS TO PROTECT YOUR KIDNEYS. Contrast dye that is sometimes used with an MRI, CT scan, or other imaging test can cause more damage to your kidneys. […] Diabetic kidney disease is a major cause of sickness and death in people with diabetes. It can lead to the need for dialysis or a kidney transplant.

• #47 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 kidney disease (DKD) can be prevented or slowed down by addressing recognised risk factors along with the preventive strategies such as: […] Preventing diabetic nephropathy requires maintaining an acceptable levels of glucose in the blood. […] One more crucial step in preventing diabetic nephropathy is blood pressure control. […] To avoid diabetic nephropathy, lipid control is also essential. […] Smoking is one established risk factor for diabetic nephropathy. […] To avoid diabetic nephropathy, kidney function must be regularly monitored. […] Diabetes-related nephropathy can also be avoided by adopting lifestyle changes like consistent exercise, a balanced diet, and weight control. […] Diabetes-related nephropathy is said to be managed with medications such as angiotensin receptor blockers and angiotensin-converting enzyme inhibitors. […] The prevention of diabetic nephropathy is mostly depends on education and awareness.

• #48

  https://journals.lww.com/md-journal/fulltext/2023/10060/comprehensive_advancements_in_the_prevention_and.63.aspx

  Blood pressure control: Controlling blood pressure is another important measure in preventing diabetic nephropathy. […] Lifestyle modifications: Lifestyle modifications such as regular physical activity, healthy eating habits, and weight management can also help prevent diabetic nephropathy. […] Medications: Medications such as angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are recommended for managing diabetic nephropathy. […] Education and awareness are crucial in preventing diabetic nephropathy. […] Overall, recent advances in the prevention and treatment of DN have provided new insights into managing this challenging complication of diabetes.

• #49 Diabetic Kidney Disease: Goals for Management, Prevention, and Awareness

  https://www.mdpi.com/2673-8392/3/3/83

  This entry will review the current preventative approach for DKD, including strict glycemic control, treatment of hypertension and hyperlipidemia, promotion of patient-driven lifestyle modifications, and incorporation of point-of care patient education. […] In summary, individualized dietary and exercise modifications, as well as smoking cessation are all non-invasive, non-pharmacological therapies and should be considered an important factor in DKD prevention and management. […] Patient-centered education on the importance of proper disease management could greatly improve general awareness of DKD and promote proactive intervention in diabetes patients. […] A thorough preventive approach for DKD includes glycemic control, treatment of hypertension and hyperlipidemia co-morbidities, and lifestyle modifications (diet, exercise, and smoking cessation).

• #50 Diabetic Kidney Disease: Prevention and Management Strategies – Associates in Nephrology, PC

  https://www.associatesinnephrologypc.com/2023/11/03/diabetic-kidney-disease-prevention-and-management-strategies/

  Nephrologists can provide valuable education and guidance regarding lifestyle modifications, dietary restrictions, and medication management specific to diabetic kidney disease. […] Early detection and intervention are key to effectively managing diabetic kidney disease. If you have diabetes, work closely with your healthcare team to develop a personalized prevention and management strategy that suits your specific needs. Together, you can reduce the risk of diabetic kidney disease and maintain optimal kidney health.

• #51 Diabetic nephropathy: Symptoms, stages, causes, and treatment

  https://www.medicalnewstoday.com/articles/319686

  Managing blood sugar levels can reduce the risk. Whether a person has type 1 or type 2 diabetes, they can reduce the risk of diabetic nephropathy by: monitoring blood glucose levels and keeping them within the target range, having a healthful diet that is low in sugar and salt, getting regular exercise, following a treatment plan, which may include the use of insulin or other medications, maintaining a healthy weight. […] Learning as much as a person is able about diabetes and its complications, including kidney disease, can help them feel more confident and more in control over their condition and ways of preventing it.

• #52 The burden of diabetic nephropathy in India: Need for prevention

  https://www.degruyter.com/document/doi/10.2478/dine-2023-0003/html?lang=en

  Diabetic nephropathy (DN) is a growing public health problem with a high economic burden. […] Therefore, the early identification and treatment of DN have been shown to slow, stop, or even reverse the progression of ESRD. […] Knowledge of CKD among patients with type 2 DM is of utmost importance as it is a step forward in prevention. […] Therefore, CKD screening is essential; ADA recommends screening for microalbuminuria 5 years after the diagnosis of type 1 and at the stage of diagnosis of type 2. […] It is imperative to understand that increased awareness and education about CKD are necessary for people with diabetes and healthcare providers. […] Prevention of CKD or a decrease in the progression of CKD will reduce the burden of DN in both patients and the nation. […] Therefore, early identification and treatment of DN have been shown to slow, stop, or even reverse disease progression and decrease kidney function.

• #53 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 urine albumin to creatinine ratio can be measured on a spot or timed urine collection such as 4 or 24 h. […] Glycemic control is essential to delay the onset of complications from diabetes, and it can be challenging for even the most experienced physician. […] Glycemic control is essential to delay or possibly prevent nephropathy. […] The data clearly show that lowering A1c leads to benefit in regards to nephropathy. […] Prevention and treatment of diabetic nephropathy and other complications necessitates a multifactorial approach through the use of a diabetologist, nephrologist, dietician, diabetes educator and additional specialists experienced in the complications of diabetes to provide a multifaceted care program to reduce progression of disease.

• #54 Diabetic Kidney Disease: Prevention and Management Strategies – Associates in Nephrology, PC

  https://www.associatesinnephrologypc.com/2023/11/03/diabetic-kidney-disease-prevention-and-management-strategies/

  Routine check-ups and kidney function tests can detect any signs of kidney damage at an early stage. […] Proper management is essential for people with diabetic kidney disease. […] Depending on the stage of diabetic kidney disease, healthcare professionals may prescribe medications to: Manage blood pressure, Control blood sugar levels, Reduce the risk of further kidney damage. […] A balanced diet with controlled sodium, protein, and phosphorus intake may be recommended for individuals with diabetic kidney disease. […] Regular follow-ups with healthcare professionals are essential for monitoring kidney function and adjusting treatment plans accordingly. […] Making certain lifestyle adjustments can have a positive impact on diabetic kidney disease management. […] When managing diabetic kidney disease, it is crucial to involve a nephrologist, a specialist in kidney health.

• #55 Diabetic Kidney Disease: Prevention and Management Strategies – Associates in Nephrology, PC

  https://www.associatesinnephrologypc.com/2023/11/03/diabetic-kidney-disease-prevention-and-management-strategies/

  If you have been diagnosed with diabetes and suspect or have been previously diagnosed with diabetic kidney disease, a nephrologist can: Confirm the diagnosis through comprehensive evaluations, including blood tests, urine tests, and imaging studies, Determine the stage of the disease. […] Visit a nephrologist if you notice a decline in kidney function, such as: Increased protein in urine, Elevated creatinine levels, Decreased glomerular filtration rate (GFR). […] If you have diabetes and struggle to manage your blood pressure effectively, consulting a nephrologist is beneficial. […] If diabetic kidney disease has progressed to advanced stages or end-stage renal disease, a nephrologist can discuss treatment options such as: Dialysis, Kidney transplantation, Other modalities, based on circumstances and preferences.

• #56 Diabetes: Medical Attention for Nephropathy

  https://qpp.cms.gov/docs/ecqm-specs/2017/EC_CMS134v5_NQF0062_Diab_Urine/CMS134v5.html

  American Association of Clinical Endocrinologists (2015): – Beginning 5 years after diagnosis in patients with type 1 diabetes (if diagnosed before age 30) or at diagnosis in patients with type 2 diabetes and those with type 1 diabetes diagnosed after age 30, annual assessment of serum creatinine to determine the estimated glomerular filtration rate (eGFR) and urine albumin excretion rate (AER) should be performed to identify, stage, and monitor progression of diabetic nephropathy. […] – Patients with nephropathy should be counseled regarding the need for optimal glycemic control, blood pressure control, dyslipidemia control, and smoking cessation. […] – Referral to a nephrologist is recommended well before the need for renal replacement therapy.

• #57 Diabetic Kidney Disease: Prevention and Management Strategies – Associates in Nephrology, PC

  https://www.associatesinnephrologypc.com/2023/11/03/diabetic-kidney-disease-prevention-and-management-strategies/

  If you have been diagnosed with diabetes and suspect or have been previously diagnosed with diabetic kidney disease, a nephrologist can: Confirm the diagnosis through comprehensive evaluations, including blood tests, urine tests, and imaging studies, Determine the stage of the disease. […] Visit a nephrologist if you notice a decline in kidney function, such as: Increased protein in urine, Elevated creatinine levels, Decreased glomerular filtration rate (GFR). […] If you have diabetes and struggle to manage your blood pressure effectively, consulting a nephrologist is beneficial. […] If diabetic kidney disease has progressed to advanced stages or end-stage renal disease, a nephrologist can discuss treatment options such as: Dialysis, Kidney transplantation, Other modalities, based on circumstances and preferences.

• #58 Diabetic Nephropathy Guidelines: Guidelines Summary

  https://emedicine.medscape.com/article/238946-guidelines

  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 […] Measures for Prevention of Diabetic Nephropathy […] 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 m2, 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 m2.

• #59 Epidemiology and Classification of Chronic Kidney Disease and Management of Diabetic Nephropathy – touchENDOCRINOLOGY

  https://touchendocrinology.com/diabetes/journal-articles/epidemiology-and-classification-of-chronic-kidney-disease-and-management-of-diabetic-nephropathy-2/

  The most common cause of chronic renal failure is diabetic nephropathy. This article examines the epidemiology and classification of CKD and the management of diabetic nephropathy. […] In the UK, diabetic nephropathy accounts for 18% of new patients commencing renal replacement therapy and makes up 11% of the prevalent patient population. […] Diabetic nephropathy progression can be slowed by effectively tightening glycaemic control, lowering blood pressure to a minimum of 130/75mmHg with ACE inhibitors or ARBs, lowering cholesterol and educating patients on how to lead a healthy lifestyle. […] The main hurdle to overcome is to ensure the implementation of guidelines and develop a global preventive approach. […] Without effective prevention and early detection programmes, the incidence rate of CKD will continue to rise. Early detection and referral of CKD patients to nephrology teams is pivotal to slowing the progression to ESRD and reducing the demand for dialysis.

• #60 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. Get tested every year if you have type 2 diabetes or have had type 1 diabetes for more than five years. […] 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. Controlling blood sugar and blood pressure might prevent or delay kidney issues and other complications. […] Diet, exercise and self-care are needed to control blood sugar and high blood pressure. Your diabetes care team can help you with the following goals: […] Talk to your health care team. Make sure all your health care professionals know that you have diabetic nephropathy. They can take steps to protect your kidneys from more damage by not doing medical tests that use contrast dye. These include angiograms and computerized tomography (CT) scans. […] In the future, people with diabetic nephropathy may benefit from treatments being developed using techniques that help the body repair itself, called regenerative medicine. These techniques may help reverse or slow kidney damage.

• #61 Treatment of Diabetic Kidney Disease: Current and Future

  https://www.e-dmj.org/journal/view.php?doi=10.4093/dmj.2020.0217

  The drugs that improve metabolic memory are awaited, and AGE inhibitors and histone modification inhibitors are the focus of clinical and basic research. […] Future studies are expected to provide new insights. […] However, DKD does not completely inhibit the progression of the disease. […] Nrf2 activator is a novel drug that improves the kidney function in DKD patients. […] HIF-PH inhibitor has been recently approved for renal anemia and has the potential to be effective against CKD and DKD by enhancing the biological response to hypoxia. […] Thus, it has the potential to be a breakthrough drug for DKD, like Nrf2 activator. […] Furthermore, by elucidating new mechanisms of metabolic memory caused by AGE and epigenetic changes in kidney, AGE and histone modification inhibitors are expected to become breakthroughs in DKD treatment.

• #62 Prevention and Treatment of Diabetic Nephropathy with Vitamin D | IntechOpen

  https://www.intechopen.com/chapters/83292

  The number of people suffering from diabetes mellitus, especially Type 2 diabetes mellitus, is increasing every year. Approximately one-third of the patients with diabetes mellitus will develop diabetic nephropathy and chronic kidney disease. Diabetic nephropathy represents the main cause of end-stage renal disease. Vitamin D deficiency is often present in patients with diabetes mellitus and could present a risk factor for a higher incidence of cardiovascular events. Vitamin D supplementation could have a renoprotective effect and the potential to delay occurrence and slow down the progression of diabetic nephropathy. […] Previous studies showed that vitamin D may have an anti-inflammatory, immunomodulatory, and hypoglycaemic effect and may affect later occurrence and slower progression of DN. These are renoprotective effects of vitamin D that are assumed that can delay the occurrence and slow down the development of DN.

• #63 Diabetic nephropathy (kidney disease)

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

  Manage high blood pressure or other medical conditions. 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. […] Don’t smoke. Cigarette smoking can damage kidneys or make kidney damage worse. If you’re a smoker, talk to a member of your health care team about ways to quit. Support groups, counseling and some medicines might help. […] Controlling blood sugar and blood pressure might prevent or delay kidney issues and other complications. […] In the future, people with diabetic nephropathy may benefit from treatments being developed using techniques that help the body repair itself, called regenerative medicine. These techniques may help reverse or slow kidney damage.

• #64 Prevention and Treatment of Diabetic Nephropathy with Vitamin D | IntechOpen

  https://www.intechopen.com/chapters/83292

  The number of people suffering from diabetes mellitus, especially Type 2 diabetes mellitus, is increasing every year. Approximately one-third of the patients with diabetes mellitus will develop diabetic nephropathy and chronic kidney disease. Diabetic nephropathy represents the main cause of end-stage renal disease. Vitamin D deficiency is often present in patients with diabetes mellitus and could present a risk factor for a higher incidence of cardiovascular events. Vitamin D supplementation could have a renoprotective effect and the potential to delay occurrence and slow down the progression of diabetic nephropathy. […] Previous studies showed that vitamin D may have an anti-inflammatory, immunomodulatory, and hypoglycaemic effect and may affect later occurrence and slower progression of DN. These are renoprotective effects of vitamin D that are assumed that can delay the occurrence and slow down the development of DN.

• #65 Prevention and Treatment of Diabetic Nephropathy with Vitamin D | IntechOpen

  https://www.intechopen.com/chapters/83292

  We can conclude that the use of vitamin D in patients with DM and DN has a significant renoprotective effect, both in patients with albuminuria and in patients without albuminuria. The particularly significant renoprotective effect of vitamin D is reflected in the stabilization of podocyte function. Vitamin D has also cardiovascular protection by decreasing albuminuria, correcting lipid status, and improving parameters of glycoregulation and inflammation.

• #66 Diabetic Kidney Disease: Goals for Management, Prevention, and Awareness

  https://www.mdpi.com/2673-8392/3/3/83

  This entry will review the current preventative approach for DKD, including strict glycemic control, treatment of hypertension and hyperlipidemia, promotion of patient-driven lifestyle modifications, and incorporation of point-of care patient education. […] In summary, individualized dietary and exercise modifications, as well as smoking cessation are all non-invasive, non-pharmacological therapies and should be considered an important factor in DKD prevention and management. […] Patient-centered education on the importance of proper disease management could greatly improve general awareness of DKD and promote proactive intervention in diabetes patients. […] A thorough preventive approach for DKD includes glycemic control, treatment of hypertension and hyperlipidemia co-morbidities, and lifestyle modifications (diet, exercise, and smoking cessation).

• #67

  https://journals.lww.com/md-journal/fulltext/2023/10060/comprehensive_advancements_in_the_prevention_and.63.aspx

  Blood pressure control: Controlling blood pressure is another important measure in preventing diabetic nephropathy. […] Lifestyle modifications: Lifestyle modifications such as regular physical activity, healthy eating habits, and weight management can also help prevent diabetic nephropathy. […] Medications: Medications such as angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are recommended for managing diabetic nephropathy. […] Education and awareness are crucial in preventing diabetic nephropathy. […] Overall, recent advances in the prevention and treatment of DN have provided new insights into managing this challenging complication of diabetes.

• #68

  https://link.springer.com/article/10.1007/s00125-005-0077-3

  Diabetic nephropathy is a major problem for patients and health care systems. […] To confront the ongoing challenge, we need to identify individuals at high risk for initiation and progression of this devastating complication. […] Modifiable risk factors should be treated aggressively. […] Interventions that aim to achieve strict glycaemic control and blockade of the renin-angiotensin system have been shown to be effective in clinical trials and are feasible in clinical practice. […] The natural history of diabetic nephropathy can be transformed if these strategies of intensive screening and care are applied, leading both to a lower incidence of diabetic nephropathy and to an improved outcome, with survival exceeding 20 years from onset of overt proteinuria. […] In order to reduce the number of patients who develop diabetic nephropathy, it is important to understand the mechanisms underlying progression.

• #69

  https://link.springer.com/article/10.1007/s00125-005-0077-3

  This review will focus upon identification of patients at risk for development and progression of diabetic nephropathy, consideration of modifiable progression promoters, and possible ways of improving treatment. […] This implies that the prognosis of microalbuminuric type 1 diabetic patients can be improved provided progression to overt nephropathy can be avoided. […] Interventions aimed at strict glycaemic control, to avoid initiation of diabetic nephropathy, and blockade of the RAS, to avoid its progression, are of demonstrated value in clinical trials and are feasible in clinical practice.

• #70 Prevention and Treatment of Diabetic Nephropathy | Abdominal Key

  https://abdominalkey.com/prevention-and-treatment-of-diabetic-nephropathy/

  Prevention and early detection of DN improve patient outcome. General measures for prevention of DN include glycemic control and rigorous BP control. […] Strict blood pressure (BP) and glycemic control early in the disease course is vital. Aggressive lipid-lowering and lifestyle modifications, including adherence to low-protein and low-sodium diet, exercise, weight loss, and smoking cessation all are beneficial and likely to improve renal and CV outcome. […] Early treatment of hypertension is critical for prevention of DN, retinopathy, and CVD. […] The role of blockade of the renin-angiotensin system (RAS) in normotensive, normoalbuminuric diabetic patients for the primary prevention of DN is unproved and cannot be recommended at this time. […] For diabetic patients with incipient or established DN, the optimal therapeutic approach to reduce the rate of progression of nephropathy and to minimize the risk for CV events involves aggressive management of hypertension with emphasis on a RAS blocker, combined with management of dyslipidemia, hyperglycemia, and albuminuria, as well as diet modification, exercise, and smoking cessation. […] In type 1 diabetic patients with microalbuminuria, ACE inhibitors reduce the risk of progression to overt nephropathy.

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