Treatment:
Prevention of diabetic nephropathy is ideally achieved by proper
control of diabetes and avoidance of smoking and obesity.
If microalbuminuria; which is a marker of very early disease; is
detected, proper control of diabetes and use of small dose of ACE
inhibitors (e.g. captopril 6.25 mg twice daily before meals) will help the
normalization of glomerular haemodynamics and prevent progression to
diabetic glomerulopathy.
In the stage of clinical proteinuria and nephrotic syndrome,
hypertension has to be controlled preferably with ACEI. This in addition
to the control of diabetes and hyperlipidemia besides the measures for
management of nephrotic syndrome.
When renal failure manifests, supportive treatment and renal
replacement therapy (RRT) may be provided. Renal replacement therapy is
usually provided earlier for diabetics (i.e. at GFR 10-15 ml/min). CAPD is
superior to haemodialysis. If transplantation is to be provided, combined
kidney and pancreas transplantation is the choice for type I diabetics and
generally steroid sparing immunosuppressive protocols are preferable.
In the near future, Pancreas islet-cell transplantation would
revolutionize the management of diabetic nephropathy.