Diabetic Nephropathy
Diabetic nephropathy, also known as diabetic kidney disease, refers to progressive kidney damage caused by long-term, poorly controlled diabetes.
Investigation and Diagnosis
ALL T2DM patients should be tested for CKD with:
- eGFR (creatinine), and
- Urine (≥3 mg/mmol is defined as clinically important proteinuria)
Management
Note that the following specifically applies to diabetic nephropathy (i.e. T2DM with CKD) but not just any CKD.
The following are extracted from the broader CKD proteinuria management covered in the Chronic Kidney Disease (CKD) article.
Management is indicated if urine ACR >3 mg/mmol:
- 1st line: ACE inhibitor or ARB
- Step-up (if urine ACR remains >3 mg/mmol): add SGLT-2 inhibitor (in addition to ACE inhibitor / ARB)
- Further step-up (click to see indications): add
ACE inhibitor / ARB and SGLT-2 inhibitor can be used for CKD generally.
However, finerenone is only indicated for those with diabetes and CKD (i.e. diabetic nephropathy) as a 3rd line add-up therapy.