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  #1  
Old 06-25-2012
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Kidney Prevention of Diabetic Nephropathy?

what is best preventive measure to control diabetic nephropathy ?

glucose control or low protein diet or hypertension control.

i have done similar q but now i dont know the answer
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Old 06-25-2012
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Umm..ACE Inhibitors!

So..I'd say hypertension control.
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Old 06-25-2012
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Quote:
Originally Posted by Merrily View Post
Umm..ACE Inhibitors!

So..I'd say hypertension control.
are u sure ? any reference ? i thought its glycemic control
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Old 06-25-2012
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Quote:
Originally Posted by Merrily View Post
Umm..ACE Inhibitors!

So..I'd say hypertension control.
I agree ACEI is important but its most significant role in diabetics is its "⬇GFR effect" as renal protection THAN its antihypertensive effect.

Of those 3 choices, I think its the glycemic control.
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Old 06-25-2012
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Well the mechanism of Diabetic nephropathy is
Glomreular hyeperfiltration leading to intraglomerular hypertension
ACE I are proven to decrease the rate of progression of nephropathy by decreasing intraglomerular hypertension

Quote:
Originally Posted by neoeinstein View Post
I agree ACEI is important but its most significant role in diabetics is its "⬇GFR effect" as renal protection THAN its antihypertensive effect.

Of those 3 choices, I think its the glycemic control.
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Old 06-25-2012
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Quote:
Originally Posted by cytokine View Post
Well the mechanism of Diabetic nephropathy is
Glomreular hyeperfiltration leading to intraglomerular hypertension
ACE I are proven to decrease the rate of progression of nephropathy by decreasing intraglomerular hypertension
yeah when I said antihypertensive effect, I was referring to ⬇afterload/⬇preload peripheral(nonrenal) effect like other antihypertensive drugs do..
I was not referring to "renal" local hypertension.

What i mean by my earlier statement is that, no other antihypertensive drug has the renoprotective effect of ACEI/ARB.
And decreasing the BP by giving simply any antihypertensive drug other than ACEI will not protect/help you against DM nephropathy the way ACEI protects it.
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Old 06-25-2012
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I think the answer will depend upon the question and the exact answer choices.
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Old 06-26-2012
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acc to uw hypertension control is more imp thn glycemic control.....uw Q ID 2190....
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Old 07-06-2012
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after encountering the uworld question:

It is still glycemic control!


You will only answer hypertension control if the kidney already develops AZOTEMIA.



And in the question stem, the pt already has azotemia that is why the answer is hypertension control.
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Old 07-07-2012
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I agree with Glycemic Control.

This is the main reason why the nephrons are damaged, and thus resulting in nephropathy.
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Endocrinology-, Internal-Medicine-, Nephrology-, Step-2-Questions

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