Treatment of diabetic nephropathy

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  • HbA1C goal (6.5-7%, 8% if aged or ≥ stage 3 CKD)
  • Risk of hypoglycemia in RF (renal failure)
  • ACEI/ARB/DRI (if not pregnant) (do not combine)
  • For H/T, microalbuminuria/proteinuria/eGFR<60
  • Efferent arteriole dilation → transiently ↓ GFR
  • Watch for hyperkalemia, AKI
  • BP:
    • Type 1 DM: ACEI, (ARB) or direct renin inhibitor (DRI)
    • Type 2 DM: ACEI, ARB or DRI
    • Plus: calcium channel blockers, diuretics, etc.
  • Low protein diet (0.8 g/kg/day)
  • In advanced CKD (≥ stage 4): “renal failure diet” (high calories, low protein, low salt, low K)