Diabetic nephropathy is treated with medicines that lower blood pressure and protect the kidneys. These medicines may reverse kidney damage and are started as soon as any amount of protein is found in the urine (microalbuminuria). The use of these medicines before nephropathy occurs may also help prevent nephropathy in people who have normal blood pressure.^{3, 4}

If you have high blood pressure, two or more medicines may be needed to lower your blood pressure enough to protect the kidneys. Medicines are added one at a time as needed. The American Diabetes Association recommends a target blood pressure of less than 130/80 millimeters of mercury (mm Hg).¹ The level recommended by other organizations may vary. Talk with your doctor about what your target blood pressure level should be. For more information on blood pressure medicines, see the topic High Blood Pressure (Hypertension).

If you take other medicines, avoid ones that damage or stress the kidneys, especially nonsteroidal anti-inflammatory drugs (NSAIDs).

It is also important to keep your blood sugar as close to normal as possible. Maintaining blood sugar levels at a close to normal level prevents damage to the small blood vessels in the kidneys.

Limiting the amount of salt in your diet can help keep your high blood pressure from becoming worse. You may also want to restrict the amount of protein in your diet. If diabetes has affected your kidneys, limiting how much protein you eat may help you preserve kidney function. Talk to your doctor or dietitian about how much protein is best for you.

People with diabetes are 2 to 4 times more likely than people who don't have diabetes to die of heart and blood vessel diseases. Using low-dose aspirin therapy and eating a low-fat diet can help prevent heart attack, stroke, and other large blood vessel disease (macrovascular disease).⁵

Initial treatment

Medicines that are used to treat diabetic nephropathy are also used to control blood pressure. If you have a very small amount of protein in your urine, these medicines may reverse the kidney damage. Medicines used for initial treatment of diabetic nephropathy include:

• Angiotensin-converting enzyme (ACE) inhibitors, such as captopril, lisinopril, ramipril, and enalapril. ACE inhibitors have been shown to protect kidney function in people with type 1 diabetes, even in those who do not have high blood pressure.⁶ ACE inhibitors can lower the amount of protein being lost in the urine. Also, they may reduce your risk of heart and blood vessel (cardiovascular) disease. One study found that ramipril cut the risk of cardiovascular disease in people with diabetes (type 1 and type 2 diabetes) by 25% to 30%.⁷
• Angiotensin II receptor blockers (ARBs), such as candesartan cilexetil, irbesartan, losartan potassium, and telmisartan. You may be given both an ACE inhibitor and an ARB. The combination of these medicines may provide greater protection for your kidneys than either medicine alone.