Diabetic Nephropathy
Diabetic nephropathy is kidney damage that develops when persistently high blood glucose injures the tiny filtering vessels inside the kidneys. It is among the leading causes of chronic kidney disease, and type 2 diabetes rates have risen sharply over the past two decades.
Key points
- A small amount of protein appearing in the urine, known as microalbuminuria, is often the earliest detectable sign.
- Rising blood pressure and declining kidney function tend to feed each other once scarring sets in, accelerating the overall decline.
- Losartan and irbesartan lower pressure within the kidney’s own filtering units, offering protection beyond their blood-pressure effect.
- Cutting dietary sodium and protein, quitting smoking and keeping a healthy weight all reinforce what medicines achieve.
How the kidneys are affected
In the early stages the kidneys actually filter more blood than normal, and the only detectable sign is a small amount of protein in the urine (microalbuminuria). Over years, without adequate blood sugar and blood pressure control, the filtering units scar and lose function. Blood pressure tends to rise as kidney function falls, and the two problems drive each other in a cycle that accelerates decline.
Slowing its progression
The most effective strategy is controlling both blood glucose and blood pressure simultaneously. Medicines that block the renin-angiotensin system, such as losartan and irbesartan, reduce pressure inside the kidney’s filtering units and are widely used to protect kidney function beyond their blood-pressure-lowering effect. More detail on this drug class is in the heart and blood pressure category. Reducing dietary sodium and protein, stopping smoking, and keeping weight in a healthy range all reinforce the effect of medicines. If protein in the urine does not come down despite treatment, a specialist review is warranted.