Diabetic Kidney Disease: Diagnosis, Treatment, and Prevention.
Am Fam Physician
; 99(12): 751-759, 2019 06 15.
Article
em En
| MEDLINE
| ID: mdl-31194487
ABSTRACT
Globally, approximately 20% of the 400 million individuals with diabetes mellitus have diabetic kidney disease (DKD). DKD is associated with higher cardiovascular and all-cause morbidity and mortality, so timely diagnosis and treatment are critical. Screening for early DKD is best done with annual spot urine albumin/creatinine ratio testing, and diagnosis is confirmed by repeated elevation in urinary albumin excretion. Treatment includes management of hyperglycemia, hypertension, hyperlipidemia, and cessation of tobacco use. Multiple antihyperglycemic medications, including sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists, and dipeptidyl-peptidase-4 inhibitors, may help prevent DKD by lowering blood glucose levels and through intrinsic renal protection. Blood pressure should be monitored at every clinical visit and maintained at less than 140/90 mm Hg to prevent microvascular changes. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers prevent progression of DKD and may decrease albuminuria. Statin therapy should be considered for all patients with DKD, and tobacco cessation reduces the risk of DKD. Given the complexity of the disease and the risk of poor outcomes, patients who progress to stage 3 DKD or beyond may benefit from referral to nephrology subspecialists.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Contexto em Saúde:
1_ASSA2030
/
2_ODS3
/
6_ODS3_enfermedades_notrasmisibles
Problema de saúde:
1_doencas_nao_transmissiveis
/
2_muertes_prematuras_enfermedades_notrasmisibles
/
6_diabetes
/
6_endocrine_disorders
/
6_kidney_renal_pelvis_ureter_cancer
Assunto principal:
Guias de Prática Clínica como Assunto
/
Diabetes Mellitus Tipo 2
/
Nefropatias Diabéticas
/
Albuminúria
/
Hipoglicemiantes
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
/
Guideline
Limite:
Adult
/
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
Am Fam Physician
Ano de publicação:
2019
Tipo de documento:
Article
País de afiliação:
Estados Unidos