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[Controlling the progression of diabetic nephropathy]
1Institut klinické a experimentální medicíny, Praha 4.
Abstract:
Diabetic nephropathy is a serious microangiopathic complication of diabetes type I and II, which accounts for a marked proportion of the high morbidity and invalidity of diabetics. Although when the disease is fully developed, progression is inevitable, ther are ways how to prevent its development and retard its course. Because reliable prediction of diabetic nephropathy is not possible, primary prevention is essential in all diabetics. It involves, as soon as the diagnosis of diabetes is established, systematic checks of the blood sugar level and permanent satisfactory compensation of diabetes (HbA1c less than 6.5%) which is the main principle during the whole subsequent course of the disease. The principle of secondary prevention the purpose of which is to prevent the development of manifest nephropathy with permanent proteinuria is monitoring of microalbuminuria and maintenance of a normal blood pressure. With regard to pathophysiological associations, in the treatment angiotensin-converting enzymes inhibitors are preferred. The objective of tertiary prevention is to delay renal insufficiency by fortified hypotensive therapy, correction of hyperlipoproteinaemia, dietary protein restriction and satisfactory compensation of diabetes. In case of renal failure dialyzation treatment or transplantation must not be delayed.
Insights
Preventing diabetic nephropathy involves managing blood sugar (HbA1c < 6.5%) and blood pressure. Early detection via microalbuminuria monitoring and interventions like ACE inhibitors can slow disease progression and delay kidney failure.
Area of Science:
- Nephrology
- Endocrinology
- Diabetology
Context:
- Diabetic nephropathy is a significant complication of type I and II diabetes, leading to high morbidity and disability.
- Early intervention is crucial as disease progression is often irreversible once established.
Purpose:
- To outline primary, secondary, and tertiary prevention strategies for diabetic nephropathy.
- To emphasize the importance of glycemic control, blood pressure management, and timely interventions.
Summary:
- Primary prevention requires immediate and continuous diabetes compensation (HbA1c < 6.5%) post-diagnosis.
- Secondary prevention focuses on monitoring microalbuminuria and maintaining normal blood pressure, with ACE inhibitors as preferred treatment.
- Tertiary prevention aims to delay renal insufficiency through intensified antihypertensive therapy, managing hyperlipoproteinemia, dietary protein restriction, and continued diabetes compensation.
Impact:
- Effective prevention and management strategies can significantly reduce the incidence and progression of diabetic nephropathy.
- Timely interventions can delay the onset of end-stage renal disease, reducing the need for dialysis or transplantation.