Diabetic nephropathy/Sclerosis
Alternative names:
diabetic glomerulosclerosis; diabetic kidney disease; Kimmelstiel-Wilson disease
Treatment:
The disorder is progressive. The goals of treatment are to slow the progression of kidney damage and control related complications.
Blood-glucose should be monitored regularly. Close control of the blood-glucose level may slow the progression of the disorder.
Medications used to manage diabetes may include oral hypoglycemic agents and/or insulin injections. The blood-glucose must be monitored and the dosage of insulin is adjusted as needed. Progression of kidney failure reduces the excretion of insulin, so smaller and smaller doses may be needed to control glucose levels.
Diet may be modified (diet for diabetics or other calorie, protein, and fat regulated diet) to help control blood-sugar levels.
Hypertension should be aggressively treated with antihypertensive medications. Uncontrolled hypertension will worsen kidney, eye, and vascular damage in the body. Control of hypertension is the most effective way of slowing kidney damage from diabetic nephropathy.
Dialysis may be necessary early in the course of renal failure.
Kidney transplant is commonly used in the treatment of diabetic nephropathy.
Contrast dyes that contain iodine are excreted through the kidney. They may worsen an already reduced glomerular filtration rate, and should be avoided if possible. If they must be used, fluids should be adequate to allow their rapid excretion.
Urinary-tract and other infections are common and should be treated effectively with appropriate antibiotics.
Renal failure should be treated as appropriate. A high serum potassium level (hyperkalemia) is common and should be treated with appropriate medications and/or dialysis.
Expectations (prognosis):
Diabetic nephropathy is a progressive disorder. Uremia and complications of chronic renal failure occur earlier and progress more rapidly than with glomerular disorders in nondiabetics.
Complications of dialysis or transplantation are more common with diabetic nephropathy, with death occurring from complications of dialysis or transplantation twice as often as in non-diabetics who require these treatments.
Complications:
Calling your health care provider:
Call your health care provider if known diabetic, and routine urinalysis shows protein.
Call your health care provider if symptoms indicate diabetic nephropathy, or if new symptoms develop, including decreased or no urine output.
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