Flow Chart Illustrating the Management of Diabetic Nephropathy after the Onset of Clinical Proteinuria - Flowchart

Flow Chart Illustrating the Management of Diabetic Nephropathy after the Onset of Clinical Proteinuria - Flowchart

Flow Chart Illustrating the Management of Diabetic Nephropathy after the Onset of Clinical Proteinuria - Flowchart Diabetic Nephropathy Diabetic Nephropathy

«Flowchart»

Proteinuria: >299 mg/day
Nephrosis: >3.5 g/day

Proteinuria: >299 mg/day
Nephrosis: >3.5 g/day

Proteinuria: >299 mg/day
Nephrosis: >3.5 g/day

Proteinuria: >299 mg/day
Nephrosis: >3.5 g/day

Immediate

Immediate

Immediate

Persistent angina
Congestive heart failure, cardiomyopathy
Respiratory disease
Autonomic neuropathy: Gastroparesis, obstipation, diarrhea, cystopathy, orthostatic hypotension
Neurologic: Cerebrovascular accident or stroke residual
Musculoskeletal disorders, renal bone disease
Infections: HIV, hepatitis, indolent ulcers
Hematologic problems other than anemia
Vision impairment (decreased acuity to blindness, loss)

Persistent angina
Congestive heart failure, cardiomyopathy
Respiratory disease
Autonomic neuropathy: Gastroparesis, obstipation, diarrhea, cystopathy, orthostatic hypotension
Neurologic: Cerebrovascular accident or stroke residual
Musculoskeletal disorders, renal bone disease
Infections: HIV, hepatitis, indolent ulcers
Hematologic problems other than anemia
Vision impairment (decreased acuity to blindness, loss)

Persistent angina
Congestive heart failure, cardiomyopathy
Respiratory disease
Autonomic neuropathy: Gastroparesis, obstipation, diarrhea, cystopathy, orthostatic hypotension
Neurologic: Cerebrovascular accident or stroke residual
Musculoskeletal disorders, renal bone disease
Infections: HIV, hepatitis, indolent ulcers
Hematologic problems other than anemia
Vision impairment (decreased acuity to blindness, loss)

Persistent angina
Congestive heart failure, cardiomyopathy
Respiratory disease
Autonomic neuropathy: Gastroparesis, obstipation, diarrhea, cystopathy, orthostatic hypotension
Neurologic: Cerebrovascular accident or stroke residual
Musculoskeletal disorders, renal bone disease
Infections: HIV, hepatitis, indolent ulcers
Hematologic problems other than anemia
Vision impairment (decreased acuity to blindness, loss)

Attain dry weight: Diuretics
BP <135/75 mm Hg: ACE inhibitors, multiple drugs
Hematocrit >35%: Erythropoietin
Hemoglobin A_1c <7%: Metabolic control
LDL cholesterol <100 mg/dL: Diet + control
Educate patient re: Regimen applied

Attain dry weight: Diuretics
BP <135/75 mm Hg: ACE inhibitors, multiple drugs
Hematocrit >35%: Erythropoietin
Hemoglobin A_1c <7%: Metabolic control
LDL cholesterol <100 mg/dL: Diet + control
Educate patient re: Regimen applied

Attain dry weight: Diuretics
BP <135/75 mm Hg: ACE inhibitors, multiple drugs
Hematocrit >35%: Erythropoietin
Hemoglobin A_1c <7%: Metabolic control
LDL cholesterol <100 mg/dL: Diet + control
Educate patient re: Regimen applied

Attain dry weight: Diuretics Attain dry weight: Diuretics
BP <135/75 mm Hg: ACE inhibitors, multiple drugs BP <135/75 mm Hg: ACE inhibitors, multiple drugs
Hematocrit >35%: Erythropoietin Hematocrit >35%: Erythropoietin
Hemoglobin A_1c <7%: Metabolic control Hemoglobin A_1c <7%: Metabolic control _1c
LDL cholesterol <100 mg/dL: Diet + control LDL cholesterol <100 mg/dL: Diet + control
Educate patient re: Regimen applied Educate patient re: Regimen applied

Monitoring

Monitoring

Monitoring

Urinary protein
Creatinine clearance
Retinopathy (cataracts)
Cardiac integrity
Bone density
Peripheral perfusion
Neurologic stability
Psychosocial adjustment

Urinary protein
Creatinine clearance
Retinopathy (cataracts)
Cardiac integrity
Bone density
Peripheral perfusion
Neurologic stability
Psychosocial adjustment

Urinary protein
Creatinine clearance
Retinopathy (cataracts)
Cardiac integrity
Bone density
Peripheral perfusion
Neurologic stability
Psychosocial adjustment

Urinary protein
Creatinine clearance
Retinopathy (cataracts)
Cardiac integrity
Bone density
Peripheral perfusion
Neurologic stability
Psychosocial adjustment

Persistent angina
Congestive heart failure, cardiomyopathy
Respiratory disease
Autonomic neuropathy: Gastroparesis, obstipation, diarrhea, cystopathy, orthostatic hypotension
Neurologic: Cerebrovascular accident or stroke residual
Musculoskeletal disorders, renal bone disease
Infections: HIV, hepatitis, indolent ulcers
Hematologic problems other than anemia
Vision impairment (decreased acuity to blindness) loss

Persistent angina
Congestive heart failure, cardiomyopathy
Respiratory disease
Autonomic neuropathy: Gastroparesis, obstipation, diarrhea, cystopathy, orthostatic hypotension
Neurologic: Cerebrovascular accident or stroke residual
Musculoskeletal disorders, renal bone disease
Infections: HIV, hepatitis, indolent ulcers
Hematologic problems other than anemia
Vision impairment (decreased acuity to blindness) loss

Persistent angina
Congestive heart failure, cardiomyopathy
Respiratory disease
Autonomic neuropathy: Gastroparesis, obstipation, diarrhea, cystopathy, orthostatic hypotension
Neurologic: Cerebrovascular accident or stroke residual
Musculoskeletal disorders, renal bone disease
Infections: HIV, hepatitis, indolent ulcers
Hematologic problems other than anemia
Vision impairment (decreased acuity to blindness) loss

Persistent angina
Congestive heart failure, cardiomyopathy
Respiratory disease
Autonomic neuropathy: Gastroparesis, obstipation, diarrhea, cystopathy, orthostatic hypotension
Neurologic: Cerebrovascular accident or stroke residual
Musculoskeletal disorders, renal bone disease
Infections: HIV, hepatitis, indolent ulcers
Hematologic problems other than anemia
Vision impairment (decreased acuity to blindness) loss

End

End

End

Assess comorbid conditions

Assess comorbid conditions

Assess comorbid conditions

Urinary protein
Creatinine clearance
Retinopathy (cataracts)
Cardiac integrity
Bone density
Peripheral perfusion
Neurologic stability
Psychosocial adjustment

Urinary protein
Creatinine clearance
Retinopathy (cataracts)
Cardiac integrity
Bone density
Peripheral perfusion
Neurologic stability
Psychosocial adjustment

Urinary protein
Creatinine clearance
Retinopathy (cataracts)
Cardiac integrity
Bone density
Peripheral perfusion
Neurologic stability
Psychosocial adjustment Urinary protein

Treat hypertension
Extract edema
Correct anemia
Strive for euglycemia
Reduce hyperlipidemia

Treat hypertension
Extract edema
Correct anemia
Strive for euglycemia
Reduce hyperlipidemia

Treat hypertension
Extract edema
Correct anemia
Strive for euglycemia
Reduce hyperlipidemia

Treat hypertension
Extract edema
Correct anemia
Strive for euglycemia
Reduce hyperlipidemia

Assess comorbid conditions

Assess comorbid conditions

Assess comorbid conditions

Treatment targets

Treatment targets

Treatment targets Treatment targets