Management of Diabetic Nephropathy.

Kim,  Nan Hee

doi:2016.17.2.102

J Korean Diabetes > Volume 17(2); 2016 > Article

Focused Issue

The Journal of Korean Diabetes 2016;17(2):102-105.
DOI: https://doi.org/10.4093/jkd.2016.17.2.102 Published online July 8, 2016.

당뇨병성신증의 관리

김난희

Management of Diabetic Nephropathy.

Nan Hee Kim

Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Seoul, Korea. nhkendo@gmail.com

Abstract

There are a few changes in the management of diabetic nephropathy (DN) in 2015 Korean Diabetes Association (KDA) Clinical Practice Guideline. Among them, restricting protein intake in patients with DN has been in controversy. Several guidelines in other countries recommend not to reduce the daily protein intake less than 0.8 g/kg/day in patients with DN, which is in agreement with the KDA guideline. Although the current KDA recommendation does not comment about high protein intake, several guidelines warn a high protein intake (> 1.3 g/kg/day) since it aggravates the progression of DN. The other issue is a target blood pressure (BP) in DN. It has been recommended that BP should be maintained at a lower level in patients with DN than in diabetic patients without nephropathy. Recently, failure to demonstrate the beneficial effects of lowering BP in reducing mortality or cardiovascular disease lead to increase the optimal BP target in diabetes from 130/80 to 140/90 mm Hg. Therefore, BP target should be individualized based on their comorbidities and life expectancy in DN patients. In this section, we recommend the optimization of BP control to reduce the risk or slow the progression of DN, rather than specify target BP levels.

Key Words: Blood pressure, Diabetic kidney disease, Diabetic nephropathies, Guideline