Treatment and Prevention of Nephropathy

Tight Control of Blood Glucose. A number of studies have shown that tight blood glucose control using intensive insulin therapy delays progression of kidney disease. High hemoglobin A1 (glycolated hemoglobin) levels may relate directly to a risk for kidney dysfunction. One study indicated, in fact, that patients could reduce the risk for kidney disease by maintaining glycolated hemoglobin levels at 8% or below rather than trying to keep strict control of glucose levels. (Such a strategy might also help prevent retinopathy.)

Controlling High Blood Pressure. Control of existing high blood pressure is extremely important not only for preventing progression to kidney failure but also to prevent heart disease, stroke, and heart failure. For diabetics, the best drugs are beta blockers or angiotensin-converting enzyme (ACE) inhibitors. Beta blockers are less expensive and one study found that they were as effective as ACE inhibitors in reducing complications of diabetes through control of blood pressure. ACE inhibitors, however, have been shown to delay the onset and progression of kidney disease by 30% to 60%, even in those without hypertension. A recent study indicates that this beneficial effect may occur mainly in people who have a specific genetic type. ACE inhibitors may even help prevent or limit progression of food ulcers and retinopathy. There is some evidence that they increase the risk for hypoglycemia.

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