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What Are the Keys to Preventing Diabetic Kidney Disease?

Robert Tanenberg, MD, FACP

Oct 1, 2004

How and when do we screen for microalbuminuria?

Annual screening for microalbuminuria (low levels of protein in the urine, indicating early signs of kidney disease) in type 1 diabetes should begin with puberty and/or after five-year disease duration of diabetes.

In patients with type 2, screening should begin at the time of diagnosis.

Consider an ACE Inhibitor

Numerous scientific studies have demonstrated that angiotensin converting enzyme (ACE) inhibitors, such as Vasotec, Altace, lisinopril and others, are the antihypertensive drugs of choice in all patients with diabetes. They reduce microalbuminuria, which is the hallmark of early diabetic kidney disease (nephropathy).

Therefore, the American Diabetes Association’s Standards of Care recommends these medications for all nonpregnant adult patients with diabetes.

Lifetime therapy with the drug is required.

Once begun, the dosage of the ACE inhibitor should be increased to the maximum tolerable dose for the greatest efficacy.

Possible reasons for the failure of ACE inhibitors to reduce microalbumin include:

Inadequate dose
Excess salt (sodium) in the diet
Another cause of kidney disease (in addition to diabetes)
Advanced kidney disease (serum creatinine over 3)

Or Maybe an ARB

If ACE inhibitors cannot be tolerated, one of the angiotensin receptor blockers (ARBs), such as Cozaar and Diovan, should be substituted.

This group of drugs has also been demonstrated to reduce albuminuria and prevent kidney failure in both type 1 and type 2 diabetes. In certain cases, physicians may prescribe both classes of drugs for patients with diabetic nephropathy or hypertension.

Other anti-hypertensive agents may be useful, but none have yet been shown to be equivalent to the ACE inhibitors or the ARB drugs in preventing or reducing diabetic nephropathy.

What are the factors that contribute to diabetic kidney disease?

Non-modifiable risk factors (you can’t change these)

Older age
Longer duration of diabetes
Genetic profile

Modifiable risk factors (you can lower these risks)

Hypertension
Hyperglycemia (A1Cs above 7%)
Cholesterol disorders
Smoking
Frequent urinary tract infections

Categories: A1c Test, Diabetes, Diabetes, Kidney Care (Nephropathy), Type 1 Issues, Type 2 Issues

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