Fast Five Quiz: Diabetic Nephropathy

A. Brent Alper, Jr, MD, MPH


April 24, 2020

Careful blood pressure control is essential for preventing the progression of diabetic nephropathy and other complications of diabetes. Generally, antihypertensive therapy slows the development of diabetic glomerulopathy, regardless of the agent used. In the UK Prospective Diabetes Study, a 12% risk reduction in diabetic complications was found with each 10 mm Hg drop in systolic pressure; the lowest risk was associated with a systolic pressure < 120 mm Hg.

Kidney and kidney-pancreas transplantation may be considered in patients prior to the initiation of dialysis. In fact, Healthy People 2020 seeks to increase the percentage of patients with end-stage kidney disease patients receiving pre-emptive transplants.

Reduction of salt intake is broadly recommended and may be particularly important for patients with diabetic nephropathy because it may help slow the progression of disease. A meta-analysis from the Cochrane Database of Systematic Reviews showed a significant reduction in blood pressure with salt restriction similar to that of single-drug therapy. The World Health Organization recommends reducing dietary salt intake to less than 5 g/d.

A significant improvement in kidney function was noted in one small study when serum urate levels were lowered to < 6.0 mg/dL in patients with T2DM and hyperuricemia. The findings may have implications for controlling and slowing the progression of diabetic complications in this population. 

Learn more about the management of diabetic nephropathy.

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