Diabetic nephropathy

E10.2/E11.2/E12.2/E13.2/E14.2 + (N18.1-5/N18.9)

DESCRIPTION

Screening

  • Check annually for proteinuria using dipstix.
  • A diagnosis of nephropathy can be made on either a positive dipstix or, if dipstix negative, send urine to laboratory for albumin:creatinine ratio. If ratio > 30 mg/g (3 mg/mmol), diagnose nephropathy.
  • Measure serum creatinine annually, and estimate eGFR.

LoEIII [10]

Diet and lifestyle

  • Limit protein intake < 0.8 g/kg daily, if proteinuric.
  • Advise smoking cessation.

MEDICINE TREATMENT

Start treatment with an ACE-inhibitor and increase gradually to maximal dose if tolerated.

  • ACE-inhibitor, e.g.:
  • Enalapril, oral, initiate with 5 mg 12 hourly.
    • Increase to maximum daily dose of 20 mg.
    • Monitor potassium, at baseline, within 1 month, and annually.

LoEI [11]

Persistent proteinuria

See Kidney and urological disorders.

Hypertension

Target BP: < 140/90 mmHg. See Hypertension.

Diabetes mellitus

Target HbA1c < 7.5%.

Intensify other renal and cardiovascular protection measures (not smoking, aspirin therapy, lipid-lowering therapy).

REFERRAL

To specialist: When eGFR < 30 mL/minute or earlier if symptomatic.