From the Guidelines
Peripheral nephropathy management should focus on controlling blood pressure and reducing proteinuria through renin–angiotensin–aldosterone system (RAAS) interruption, as well as lifestyle interventions such as reduced sodium intake, achieving a healthy body mass index, smoking cessation, and regular exercise. This approach is supported by the most recent and highest quality study, which emphasizes the importance of controlling blood pressure and reducing proteinuria to prevent chronic kidney disease (CKD) progression 1.
Key Management Strategies
- Control of blood pressure to slow CKD progression
- Reduction of proteinuria using RAAS interruption, such as angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers
- Lifestyle interventions, including:
- Reduced sodium intake to <2 g per day
- Achieving a healthy body mass index of 20 to 25 kg/m2
- Smoking cessation
- Exercising for 30 minutes, 5 times per week
- Good diabetes control, with a target hemoglobin A1c level of 7%, to reduce the risk or slow the progression of nephropathy 1
Additional Considerations
- Annual screening for microalbuminuria to identify patients with nephropathy at an early stage 1
- Aggressive antihypertensive treatment and the use of ACE inhibitors or ARBs to slow the rate of progression of nephropathy 1
- Protein restriction and other treatments as needed to manage CKD progression 1
From the FDA Drug Label
To slow the worsening of diabetic kidney disease (nephropathy) in patients with type 2 diabetes who have or had high blood pressure. The FDA drug label does not answer the question about peripheral nephropathy management.
From the Research
Management of Peripheral Nephropathy
Peripheral nephropathy, also known as diabetic nephropathy, is a leading cause of kidney disease. The management of this condition involves several strategies, including:
- Blood Pressure Control: Controlling blood pressure is crucial in managing peripheral nephropathy. Studies have shown that lowering blood pressure can slow the progression of kidney disease 2, 3.
- Blood Sugar Control: Maintaining good blood sugar control is also essential in managing peripheral nephropathy. The Diabetes Control and Complications Trial demonstrated that intensive blood sugar control can reduce the risk of developing microalbuminuria and proteinuria 2.
- ACE Inhibitors: Angiotensin-converting enzyme (ACE) inhibitors have been shown to be effective in slowing the progression of kidney disease in patients with peripheral nephropathy. They work by reducing blood pressure and decreasing proteinuria 4, 5.
- Dietary Protein Restriction: Restricting dietary protein intake may also be beneficial in slowing the progression of kidney disease in patients with peripheral nephropathy 2, 6.
- Lipid Management: Managing lipid levels is also important in patients with peripheral nephropathy, as elevated lipid levels can increase the risk of cardiovascular disease 3.
Treatment Strategies
The treatment of peripheral nephropathy involves a multifaceted approach, including:
- Medications: ACE inhibitors, angiotensin II receptor antagonists, and other medications may be used to control blood pressure and reduce proteinuria.
- Lifestyle Modifications: Patients with peripheral nephropathy should be encouraged to make lifestyle modifications, such as maintaining a healthy diet, exercising regularly, and quitting smoking.
- Regular Monitoring: Regular monitoring of kidney function, blood pressure, and lipid levels is essential in managing peripheral nephropathy.
Benefits of Early Intervention
Early intervention is crucial in managing peripheral nephropathy. Studies have shown that early treatment can slow the progression of kidney disease and reduce the risk of cardiovascular complications 2, 3.