Early diagnosis

Since the clinical picture of diabetic nephropathy occurs in the majority of people suffering from “sugar”, patients should be examined annually for the presence of the nephropathy. The early detection examination includes, among other things, determination of the amount of albumin in the morning urine; if this is below 20 mg/l, damage to the kidneys in the form of diabetic nephropathy is not to be assumed. However, if increased albumin excretion is detected in two out of three urine samples, therapy with so-called ACE inhibitors/AT1 receptor blockers (see below) is initiated immediately.

Therapy

The main goals of the therapy are to reduce the risk of cardiovascular complications such as heart attack or stroke and to inhibit the progression of the disease by increasingly limiting the function of the kidney. The therapy consists of two drug-based pillars: Blood pressure-lowering therapy must be started immediately after the diagnosis of diabetic nephropathy, regardless of the stage of the disease. The goal is to lower the blood pressure permanently below 130-139/80-85 mmHg in type II diabetics.

Furthermore, the therapy aims at a maximum protein excretion of 0.5 to 1 gram per day. First-line therapeutics are the already mentioned angiotensin inhibitors (ACE inhibitors, AT1 receptor blockers), which inhibit the blood pressure regulation of the kidney and also have a proven protective effect on the kidney against further damage (inhibition of the remodelling processes and scar formation). Since elevated levels of blood lipids (LDL cholesterol) are another risk factor for cardiovascular complications, these are also treated in stages one to four, with a target value of < 100 mg/dl.

Initiation of this therapy is no longer appropriate in stage V, which is associated with renal replacement therapy, and is therefore normally not initiated. In addition to drug therapy, patients with diabetic nephropathy are also advised to increase their fluid intake, taking care not to exceed 60 to 80 grams of protein per day. Furthermore, weight normalization (BMI 18.5 to 24.9 kg/m2) is recommended.

Control of the blood sugar level, if necessary with adjustment of the therapy
Blood pressure reduction