Gross et al identified a number of management goals and strategies for a patient with diabetic nephropathy. The authors are from Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.


Preserving renal function:

(1) with microalbuminuria: The goals are to minimize microalbuminuria and to stabilize the glomerular filtration rate (GFR).

(2) with macroalbuminuria: The goals are to minimize proteinuria (ideally < 500 mg per 24 hours) and to keep any decline in GFR to < 2 mL per minute per year

(3) medications include angiotensin converting enzyme (ACE) inhibitor and/or angiotensin receptor blockade (ARB)

(4) A diet low in protein (0.6 to 0.8 grams per kg body weight per day) should be considered (not proven to be of benefit for patients with microalbuminuria).


Control of blood pressure:

(1) < 130/80 mm Hg: if the patient has a normal serum creatinine and proteinuria <= 1 g per 24 hours

(2) < 125/75 mm Hg: if the patient has an elevated serum creatinine and/or proteinuria > 1 g per 24 hours


Control of cholesterol levels with statins:

(1) LDL cholesterol <= 100 mg/dL without cardiovascular disease

(2) LDL cholesterol < 70 mg/dL with cardiovascular disease


Additional control measures:

(1) Prevention of thrombosis: with aspirin (acetylsalicylic acid) if tolerated

(2) Smoking cessation

(3) Strict glycemic control with hemoglobin A1c maintained < 7%


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