Diabetic Nephropathy

Description

Medicine Treatment 

Referral

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ICD-10 Code: E10.2/E11.2/E12.2/E13.2/E14.2 + (N18.1-5/N18.9)

DESCRIPTION

Screening

• Check annually for proteinuria using dipstix
• A diagnosis of nephropathy can be made on either a positive dipstix or, if dipstix negative, send urine to laboratory for albumin: creatinine ratio. If ratio >30 mg/g (3 mg/mmol), diagnose nephropathy
• Measure serum creatinine annually, and estimate eGFR

LoE: III¹⁸⁰

Diet and lifestyle

• Limit protein intake <0.8 g/kg daily, if proteinuric
• Advise smoking cessation

MEDICINE TREATMENT

Start treatment with an ACE-inhibitor and increase gradually to maximal dose if tolerated.

• ACE-inhibitor, e.g.:
• Enalapril, oral, initiate with 5 mg, 12 hourly
  • Increase to maximum daily dose of 20 mg 
  • Monitor potassium, at baseline, within 1 month, and annually 

LoE: I¹⁸¹

Persistent proteinuria

• See: Kidney and Urological Disorders 

Hypertension

• Target BP: <140/90 mmHg. See: Hypertension in Adults, Hypertensive Emergency and Hypertension in Children 

Diabetes mellitus

• Target HbA1c <7.5%
• Intensify other renal and cardiovascular protection measures (not smoking, aspirin therapy, lipid-lowering therapy)

REFERRAL

• To specialist: When eGFR < 30 mL/minute or earlier if symptomatic

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare Level, 2024 Edition