ACE inhibitors have been shown to delay the progression of diabetic nephropathy in patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). For example, long-term treatment with ACE inhibitors, normally in combination with diuretics, reduces blood pressure and albuminuria and protects kidney function in patients with hypertension, T1DM, and nephropathy. Favorable effects on kidney function have also been reported in patients with normotension, T1DM, and nephropathy. In patients with T2DM, 12 months of treatment with ACE inhibition significantly reduced mean arterial blood pressure and urinary albumin excretion rate.
Renin-angiotensin system inhibition with ARBs has been shown to be effective for the treatment of both type 1 and type 2 diabetic nephropathy. Several studies have shown ARBs slow the progression to diabetic nephropathy in patients with T2DM.
Data suggest vitamin D supplementation may be beneficial for lowering proteinuria in patients with diabetic nephropathy. Patients with diabetic nephropathy with stage 3 chronic kidney disease (estimated glomerular filtration rate [GFR], 59-30 mL/min/1.73 m2) or a more advanced stage should be evaluated for their vitamin D and parathyroid hormone status as recommended by the National Kidney Foundation Kidney Disease Outcomes Quality Initiative. If vitamin D levels are low, patients should be given vitamin D supplementation as recommended for patients with low vitamin D levels.
Dual therapy with ACE inhibitors and ARBs has been associated with increased rates of adverse events and no benefits for preventing diabetic kidney disease or cardiovascular disease in patients with diabetes. As such, the combination of ACE inhibitors and ARBs should be avoided.
Learn more about the treatment of diabetic nephropathy.
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Cite this: A. Brent Alper. Fast Five Quiz: Diabetic Nephropathy Management - Medscape - Apr 24, 2020.