The goals of treatment are to slow the progression of kidney damage and control related complications. Management of<unk>  currently centers over four main areas: Cardiovascular risk reduction, glycemic control, blood pressure control as well as inhibition of the RAAS system. Cardiovascular risk reduction: Patients with diabetes mellitus are at significantly increased risk of cardiovascular disease, which is also an independent risk factor for kidney failure. Therefore, it is important to aggressively manage cardiovascular risk factors in patients with diabetes mellitus and in particular those with<unk> . The main components of managing cardiovascular disease is with tobacco cessation, lipid-lowering therapies (e.g., statins) as well as regular exercise and healthy eating. In patients with kidney disease, atorvastatin is preferred over other statins as it does not require dose-adjustment based on GFR. Glycemic control: Multiple studies have found a positive effect of improved glycemic control on clinical outcomes of patients with<unk> . Intensive glycemic control also reduces the rate of other DM complications, such as retinopathy and neuropathy. Glycemic control is maintained mainly with insulin in patients with Type 1 DM and with hypoglycemic agents and/or insulin in patients with type 2 DM. Studies showed a decrease in microvascular complications of<unk>  with a target goal HbA1c concentration of 7%. Further reduction in the HbA1c did not correlate with better outcomes and is thus not recommended in most patients as it could increase the risk of hypoglycemic episodes. Blood pressure control: Multiple randomized clinical trials have demonstrated a benefit of decreasing systolic blood pressure to <140 mmHg in patients with<unk> . High blood pressure is associated with accelerated development of microalbuminuria, over proteinuria and declining kidney function. Angiotensin-converting-enzyme inhibitors, as well as angiotensin II receptor blockers, are particularly helpful in patients with diabetes to lower blood pressure and slow the progression of nephropathy. More intensive blood pressure lower (125-130/<80) in patients with<unk>  mellitus has been shown to decrease the risk of progression of<unk>  as well as other<unk>  complications. Some patients might require dual therapy to adequately control pressure, in which case calcium channel blockers or diuretics are a good second-line option. RAAS inhibition: Inhibition can be achieved with multiple therapies, mainly ACE inhibitors, angiotensin receptor blockers, direct renin inhibitors, and mineralocorticoid antagonists. RAAS inhibition has been proven to be the most effective therapy to slow the progression of<unk>  in all stages. Although RAAS blockade using more than one agent may further reduce proteinuria, the risk of adverse events (such as hyperkalemia, acute kidney injury) outweigh the potential benefits. Therefore, it is recommended that only one agent is used in patients with DM who have hypertension or any signs of microalbuminuria or<unk> . About half of insulin is metabolized and cleared by the kidneys. This means that as kidney function worsens in the setting of<unk> , some patients with insulin-dependent DM may find that their regular insulin doses are lasting longer than normal, or that they are experiencing an increasing frequency of hypoglycemic episodes. It is also crucial to closely monitor kidney function to properly dose medications that are cleared by the kidneys. Some of the most commonly used nephrotoxic medications are non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. With worsening kidney function, it might also be necessary to follow a renal-diet to avoid complications such as hyperkalemia and metabolic acidosis. Some evidence suggests that limiting dietary protein could slow the progression of<unk> , but further evidence is needed to confirm this benefit. Patients with<unk>  might go on to develop end stage renal disease and require kidney transplantation or hemodialysis. Emerging therapies A relatively new medication that has been approved for treatment for DM is sodium glucose cotransporter 2 (SGLT2) inhibitors. The mechanism of action of this drug is to the sodium-glucose uptake cotransporter in the proximal tubule, thereby generating naturesis and glucosuria. In multiple clinical trials, SGLT2 inhibitors showed improved cardiovascular outcomes in patients with DM as well a positive effect on kidney outcomes, mainly a reduction in albuminuria and progression of renal damage. Other classes of<unk>  medications that have been shown to have a positive effect on the progression of<unk>  are GLP-1 agonists and DPP-4 inhibitors. Education and self-management The success of<unk>  management depends greatly upon the ability of individuals to self-manage this condition, encompassing glycaemic control, and the adoption of healthy lifestyles. Appropriate self-management often requires patient education and behavioural counselling. However, there is still insufficient evidence to draw conclusions regarding the effects, regarding both benefits and harms, of educational programmes for people with<unk> . Further high-quality studies are warranted.
Diabetic nephropathy
Analgesic nephropathy
IgA nephropathy
Benign nephrosclerosis
Malarial nephropathy
Phosphate nephropathy
Reflux nephropathy
Sickle cell nephropathy