Diabetic Nephropathy medications & treatments
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Diabetic nephropathy is a complication of diabetes mellitus that affects about 33% of diabetics in the United States. Although both type 1 and type 2 diabetes can lead to diabetic nephropathy, patients with type 1 diabetes are more likely to develop end-stage renal disease (ESRD). Almost half of all cases of ESRD in the U.S. are due to diabetes.
What is diabetic nephropathy?
Diabetic nephropathy, or diabetic kidney disease (DKD), is a progressive kidney disease that affects people with type 1 and type 2 diabetes. High blood sugar levels can damage the blood vessels in your kidneys that filter blood to make urine. The damaged filter will begin to leak protein into your urine. If the damage continues, your kidneys will gradually lose their ability to remove waste products from the blood.
Diabetic nephropathy causes
While the exact cause of diabetic nephropathy is unknown, high blood sugar (hyperglycemia) and high blood pressure (hypertension) are thought to be the 2 main risk factors for this condition. Some other factors that increase your risk of diabetic nephropathy include:
- Certain ethnic groups including African-Americans, Hispanics, or American Indians
- Heart disease
- Family history of diabetes or kidney failure
- Type 1 diabetes before the age of 20
- High cholesterol
How is diabetic nephropathy diagnosed?
Diabetic nephropathy is typically diagnosed during regular appointments for diabetes care. If you have diabetes, your healthcare provider should routinely test you for signs of kidney damage. According to the American Diabetes Association (ADA), you should be screened once a year beginning 5 years after your diagnosis with type 1 diabetes and immediately after being diagnosed with type 2 diabetes. Some routine screening tests include:
- Microalbuminuria urine test. This test is used to check for the blood protein albumin in your urine. Your urine does not normally contain albumin, so the presence of the protein in your urine is a sign of kidney damage. This urine sample is usually collected as your first urine of the day or during your doctor’s visit.
- Glomerular filtration rate (GFR). Creatinine is a waste product that your kidneys filter out of the blood and release with urine. This test measures the amount of creatinine in your blood (serum creatinine) to determine how quickly the kidneys filter blood. The GFR in a fully functioning kidney is 100%. A GFR between 15% and 60% indicates there is renal dysfunction and below 15%, renal failure.
- Spot albumin/creatinine ratio. The ratio of albumin to creatinine in your urine can determine how well your kidneys are functioning.
- Blood urea nitrogen blood test (BUN). A BUN measures the amount of urea nitrogen in your blood. An elevated level can be an indicator of kidney failure.
- Kidney biopsy. Your doctor may take a sample of tissue from your kidney and examine it under a microscope if non-diabetic kidney disease is suspected.
Diabetic nephropathy symptoms
Most people will not notice any signs or symptoms in the early stages of diabetic nephropathy. If it progresses to end-stage kidney disease, you may begin to experience symptoms such as:
- Swelling in your feet, lower legs, or hands
- Protein and blood in your urine
- Decreased urination
- Loss of appetite
- Nausea and vomiting
- Shortness of breath
- Dry, itchy skin
- High blood pressure
What are some diabetic nephropathy treatment options?
Routine screening to detect worsening kidney function is important to be able to start treatment to delay or prevent the progression of diabetic nephropathy. This can be accomplished by intensive management of diabetes and blood pressure through medications and lifestyle changes.
- ACE inhibitors. Angiotensin-converting enzyme inhibitors are used for blood pressure control while protecting your kidneys from further damage. Some examples include Zestril (lisinopril), Lotensin (benazepril), and Altace (ramipril)
- Angiotensin receptor blockers (ARBs). ARBs are an alternative medication to use in place of ACE inhibitors. They provide the same blood pressure control and kidney protection while having fewer side effects. Some examples include Cozaar (losartan) and Avapro (irbesartan).
- Glucagon-like peptide 1 (GLP-1) receptor agonists. These medications help maintain blood glucose control by slowing digestion and stimulating insulin release in response to increased glucose levels. Examples include Byetta (exenatide) and Ozempic (semaglutide).
- SGLT-2 inhibitors. Medications such as Farxiga (dapagliflozin) and Jardiance (empagliflozin) increase glucose excretion in the urine to help lower blood sugar. They can help slow chronic kidney disease (CKD) progression and reduce the risk of cardiovascular events.
- Kerendia (finerenone). This medication may reduce GFR decline, cardiovascular death, nonfatal heart attacks, and hospitalization for heart failure in adults with CKD associated with type 2 diabetes.
- Statins. Your doctor may prescribe cholesterol-lowering drugs such as Lipitor (atorvastatin) to help reduce protein in your urine (proteinuria).
If your disease continues progressing, your doctor may recommend:
- Dialysis. Kidney dialysis is used to filter the waste out of your blood. There are two main types: hemodialysis and peritoneal dialysis. Hemodialysis is the more common method and is typically done in a dialysis center. While peritoneal dialysis is not suitable for everyone, it allows you more flexibility as it can be done at home, at work, or while traveling.
- Kidney transplant. For some type 1 diabetics with ESRD, simultaneous pancreas/kidney transplantation is an effective treatment. Most patients who have this procedure done achieve insulin independence and have no recurrence of diabetic nephropathy.
What is the best medication for diabetic nephropathy?
The best medication for the treatment of diabetic nephropathy will depend on the individual’s specific medical condition, medical history, medications that the individual is already taking that may potentially interact with diabetic nephropathy medications, and the individual’s potential response to the treatment. It is advisable to always speak with your healthcare provider about the best medication for you. The table below includes a list of the most prescribed or over-the-counter diabetic nephropathy medications approved by the Food and Drug Administration (FDA).
Best medications for diabetic nephropathy
|Drug name||Drug class||Administration route||Standard dosage||Common side effects
|Zestril (lisinopril)||ACE inhibitor||Oral||20mg to 40mg once daily.||Dizziness, low blood pressure, cough, headache, high potassium levels (hyperkalemia)
|Lotensin (benazepril)||ACE inhibitor||Oral||10mg to 20mg once daily.||Cough, headache, dizziness, fatigue, drowsiness, nausea
|Altace (ramipril)||ACE inhibitor||Oral||2.5mg to 20mg once daily or divided every 12 hours.||Cough, low blood pressure, headache, chest pain, dizziness, nausea
|Capoten (captopril)||ACE inhibitor||Oral||25mg every 8 hours.||High potassium levels, rash, low blood pressure, altered taste, cough, chest pain
|Accupril (quinapril)||ACE inhibitor||Oral||20mg to 80mg once daily or divided every 12 hours.||Dizziness, cough, fatigue, nausea, vomiting, low blood pressure, diarrhea
|Diovan (valsartan)||Angiotensin II receptor blocker||Oral||80mg to 320mg once daily.||Cough, dizziness, low blood sugar, diarrhea, joint pain, fatigue
|Atacand (candesartan)||Angiotensin II receptor blocker||Oral||8mg to 32mg once daily or divided every 12 hours.||Dizziness, fatigue, diarrhea, chest pain, joint pain, cough
|Micardis (telmisartan)||Angiotensin II receptor blocker||Oral||20mg to 80mg once daily.||Upper respiratory tract infection, back pain, diarrhea, cough, sore throat
|Byetta (exenatide)||GLP-1 agonist||Injection||5mcg to 10mcg under the skin every 12 hours 1 hour before a meal.||Injection site reactions, nausea, vomiting, diarrhea, constipation, headache
|Ozempic (semaglutide)||GLP-1 agonist||Injection||0.5mg to 2mg under the skin once a week.||Nausea, low blood sugar, vomiting, diarrhea, stomach pain, constipation, indigestion
|Farxiga (dapagliflozin)||SGLT-2 inhibitor||Oral||10mg once daily.||Infections, back pain, nausea, constipation, increased urination
|Jardiance (empagliflozin)||SGLT-2 inhibitor||Oral||10mg to 25mg once daily.||Infections, increased urination, joint pain, nausea
|Kerendia (finerenone)||Selective aldosterone antagonist||Oral||10mg to 20mg once daily depending on your renal function.||High potassium levels, low blood pressure, low sodium levels
|Lipitor (atorvastatin)||Statin||Oral||10mg to 80mg once daily.||Diarrhea, common cold, joint pain, insomnia, nausea, muscle pain
|Zocor (simvastatin)||Statin||Oral||5mg to 40mg once daily in the evening.||Constipation, upper respiratory infection, gas, headache, muscle pain, dizziness
Your healthcare provider will determine the right dosage based on your response to the treatment, medical condition, weight, and age. Other possible side effects may exist; this is not a complete list.
What are the most common side effects of diabetic nephropathy medications?
As with all medicines, those used for diabetic nephropathy will have some side effects, depending on the class you are taking:
- ACE inhibitors and ARBs: Cough, headache, dizziness, fatigue, nausea, low blood pressure, chest pain, high potassium levels
- GLP-1 agonists: Injection site reactions, nausea, vomiting, diarrhea, constipation, headache, low blood sugar
- SLG-2 inhibitors: Infections, joint pain, nausea, constipation, increased urination.
- Kerendia (finerenone): High potassium levels, low blood pressure, low sodium levels
- Statins: Diarrhea, common cold symptoms, joint pain, insomnia, nausea, muscle pain, gas, constipation, headache
What are some home remedies for diabetic nephropathy?
While medications to manage your diabetes and blood pressure are essential, there are lifestyle changes and self-care measures that can help reduce your risk of diabetic nephropathy.
Diabetic nephropathy prevention
Your doctor may recommend the following to lower your risk of developing diabetic nephropathy:
- Manage your blood sugar and blood pressure. Keeping your blood sugar and blood pressure within their targeted range may prevent diabetic nephropathy.
- Quit smoking. Smoking can worsen or cause new kidney damage. Talk with your doctor about a plan to stop smoking.
- Lose weight if you are overweight and then work hard to maintain it.
- Eat a healthy diet that’s low in sodium. Try including healthy foods like lean meats, whole grains, and healthy fats.
- Exercise regularly to help maintain a healthy weight. Exercise can also help reduce your blood pressure.
- Go to all of your follow-up appointments so your doctor can help manage your condition or screen you for complications.
Frequently asked questions about diabetic nephropathy
Can diabetic nephropathy be cured?
Diabetic nephropathy cannot usually be cured. It is a progressive disease that slowly worsens over time. However, medications and lifestyle changes can help protect your kidneys and prevent complications. The sooner you are diagnosed and begin treatment, the better your chance is of slowing the progression of the disease.
When should I be screened for diabetic nephropathy?
You should be screened yearly if you have any of the following:
- Type 1 diabetics should be screened starting 5 years after diagnosis
- Juvenile diabetics should be screened at puberty
- Type 2 diabetics should be screened immediately after diagnosis
What medications should I avoid with diabetic nephropathy?
Common medications to avoid are NSAIDs (nonsteroidal anti-inflammatory drugs), antacids, and herbal supplements that contain potassium or phosphorus.
Certain drugs such as diabetes medications, statins for cholesterol, and antibiotics that are cleared by the kidney might need their dosage adjusted if you have diabetic nephropathy.
What are some complications of diabetic nephropathy?
Complications of diabetic nephropathy that may develop gradually over time include:
- Kidney failure
- Fluid retention
- Microvascular complications such as diabetic retinopathy and neuropathy
- Cardiovascular disease
- Bone disease and increased risk of fractures
- Elevated potassium levels (hyperkalemia)
- Metabolic acidosis (buildup of acid in your body)
- Pruritis (itchy skin)
Related resources for diabetic nephropathy
The content on this website is intended for information purposes only. It does not constitute medical advice. The information on this website should not be relied upon and is not a substitute for professional medical advice. You should always speak to your doctor regarding the risks and benefits of any treatment.