Diabetic nephropathy is treated with medicines that lower blood pressure and protect the kidneys. These medicines may slow down kidney damage and are started as soon as any amount of protein is found in the urine. The use of these medicines before nephropathy occurs may also help prevent nephropathy in people who have normal blood pressure.
Limiting the amount of salt in your diet can help keep your high blood pressure from getting worse. You may also want to restrict the amount of protein in your diet. If diabetes has affected your kidneys, limiting how much protein you eat may help you preserve kidney function. Talk to your doctor or dietitian about how much protein is best for you.
Medicines that are used to treat diabetic nephropathy are also used to control blood pressure. If you have a very small amount of protein in your urine, these medicines may reverse the kidney damage. Medicines used for initial treatment of diabetic nephropathy include:
- Angiotensin-converting enzyme (ACE) inhibitors, such as captopril, enalapril, lisinopril, and ramipril. ACE inhibitors can lower the amount of protein being lost in the urine. Also, they may reduce your risk of heart and blood vessel (cardiovascular) disease.
- Angiotensin II receptor blockers (ARBs), such as candesartan cilexetil, irbesartan, losartan potassium, and telmisartan.
If you also have high blood pressure, two or more medicines may be needed to lower your blood pressure enough to protect your kidneys. Medicines are added one at a time as needed.
If you take other medicines, avoid ones that damage or stress the kidneys, especially nonsteroidal anti-inflammatory drugs (NSAIDs).
It is also important to keep your blood sugar within your target range to prevent damage to the small blood vessels in the kidneys.
As diabetic nephropathy progresses, blood pressure usually rises, making it necessary to add more medicine to control blood pressure.
Your doctor may advise you to take the following medicines that lower blood pressure. You may need to take different combinations of these medicines to best control your blood pressure. By lowering your blood pressure, you may reduce your risk of kidney damage. Medicines include:
- Angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs).
- Calcium channel blockers, which lower blood pressure by making it easier for blood to flow through the vessels. Examples include amlodipine, diltiazem, or verapamil.
- Diuretics. Medicines such as chlorthalidone, hydrochlorothiazide, or spironolactone help lower blood pressure by removing sodium and water from the body.
- Beta-blockers lower blood pressure by slowing down your heartbeat and reducing the amount of blood pumped with each heartbeat. Examples include atenolol, carvedilol, or metoprolol.
Continue to avoid other medicines that may damage or stress the kidneys, especially nonsteroidal anti-inflammatory drugs (NSAIDs). And it is still important to keep your blood sugar within your target range, eat healthy foods, get regular exercise, and not smoke.
Treatment if the condition gets worse
If damage to the blood vessels in the kidneys continues, kidney failure may eventually develop. When that occurs, it is likely that you will need dialysis treatment (renal replacement therapy)-an artificial method of filtering the blood-or a kidney transplant to survive. To learn more, see the topic Chronic Kidney Disease.
What to think about
Diabetic nephropathy can get worse during pregnancy and can affect the growth and development of the fetus. If your nephropathy is not severe, your kidney function may return to its prepregnancy level after the baby is born. If you have severe nephropathy, pregnancy may lead to permanent worsening of your kidney function.
If you have nephropathy and are pregnant or are planning to become pregnant, talk with your doctor about which medicines you can take. You may not be able to take some medicines (for example, angiotensin-converting enzyme [ACE] inhibitors or angiotensin II receptor blockers [ARBs]) during pregnancy, because they may harm your developing baby.
Prevention is the best way to avoid kidney damage from diabetic nephropathy.
- Keep your blood sugar levels within your target range. Manage your blood sugar by eating healthy foods, taking your medicine, and getting regular exercise. Your doctor may want you to check your blood sugar several times each day.
- Have yearly testing for protein in your urine.
- If you have type 1 diabetes, begin urine tests for protein after you have had diabetes for 5 years.
- Children with type 1 diabetes should begin yearly urine protein screening when they are 10 years of age and have had diabetes for 5 years.
- If you have type 2 diabetes, begin screening at the time diabetes is diagnosed.
- Keep your blood pressure under control with medicine, diet, and exercise. Learn to check your blood pressure at home.
- Stay at a healthy weight. This can help you prevent other diseases, such as high blood pressure and heart disease.
- Follow the nutrition guidelines for hypertension (including the Dietary Approaches to Stop Hypertension, or DASH, diet).
- Do not smoke or use other tobacco products.
If you already have diabetic nephropathy, you may be able to slow the progression of kidney damage by:
- Avoiding dehydration by promptly treating other conditions-such as diarrhea, vomiting, or fever-that can cause it. Be especially careful during hot weather or when you exercise.
- Reducing your risk of heart disease. Lifestyle changes such as eating a heart-healthy diet, quitting smoking, and getting regular exercise can help reduce your overall risk of developing heart disease and stroke.
- Treating other conditions that may block the normal flow of urine out of the kidneys, such as kidney stones, an enlarged prostate, or bladder problems.
- Not using medicines that may be harmful to your kidneys, especially nonsteroidal anti-inflammatory drugs (NSAIDs). Be sure that your doctor knows about all prescription, nonprescription, and herbal medicines you are taking.
- Avoiding X-ray tests that require IV contrast material, such as angiograms, intravenous pyelography (IVP), and some CT scans. IV contrast can cause further kidney damage. If you do need to have these types of tests, make sure your doctor knows that you have diabetic nephropathy.
- Avoiding situations where you risk losing large amounts of blood, such as unnecessary surgeries. Do not donate blood or plasma.
- Lowering your blood pressure, because high blood pressure can make kidney damage even worse.
- Checking with your doctor to find out if it is safe for you to drink alcohol. Limiting alcohol can lower your blood pressure and lower your risk of kidney damage.