Preventing and Treating Diabetic Kidney Damage

Preventing and Treating Diabetic Kidney Damage Controlling blood sugar and blood pressure has been the key to preventing and treating diabetic kidney damage. ACE inhibitors treat hypertension best. However, a patient may not respond.

ACE inhibitors and dihydropyridine calcium channel blockers prevent cardiovascular events better than ACE inhibitors and thiazide diuretics (Forst et al., 2022). For persons with illnesses that benefit from thiazide diuretics, combining an ACE inhibitor (or ARB) with one is also a smart option (edema, osteoporosis, calcium nephrolithiasis with hypercalciuria). Combination therapy reduces blood pressure more than a single treatment and increases the likelihood of reaching the goal in an acceptable time (Forst et al., 2022). Two drugs can lower blood pressure with lower doses, reducing negative effects. ACE inhibitors reduce urine protein. Hence, we will combine ACE inhibitors and dihydropyridine calcium channels into a single pill.

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The patient requires extra blood sugar-lowering medication because insulin therapy has failed.

Insulin can be taken alongside other medications because it functions independently, according to Sharaf El Din et al. (2017). Even if HbA1c drops the same amount, canagliflozin lowers blood sugar better than glimepiride because eGFR drops less. Canagliflozin also protects the kidneys independently of blood sugar. T2DM individuals with stage 3a and 3b CKD lost weight and blood pressure (Sharaf El Din et al., 2017). Canagliflozin with insulin would alter blood sugar stabilization.

As diabetes is considered coronary heart disease, intensively lowering lipids is crucial to managing it. Table 1 demonstrates that the patient's lipid-lowering statins have not worked.

Increasing statin doses may be safe or beneficial, even though they lower lipids better. Statins may cause myopathy and Type 2 diabetes (de Bhails et al., 2021). We now recommend statin and fibrate therapy to reduce lipid levels instead of increasing statin doses. The combo improves T2DM lipids.

Vitamin D receptor agonists (paricalcitol 2 g per day) lower urine albumin by a substantial amount (de Bhails et al., 2021). So, it will be one of our changes to lower urine albumin.

Bardoxolone methyl improves the glomerular filtration rate. It benefits T2D patients (de Bhails et al., 2021). (CKD). The new regimen includes bardoxolone due to the patient's high GFR.