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Table 2—

Strategies and goals for reno- and cardioprotection in patients with diabetic nephropathy

InterventionGoal
MicroalbuminuricMacroalbuminuric
ACE inhibitor and/or ARB and low-protein diet (0.6–0.8 g · kg wt−1 · day−1 Reduction of albuminuria or reversion to normoalbuminuria Proteinuria as low as possible or <0.5 g/24-h and 
 GFR stabilization GFR decline <2 ml · min−1 · year−1 
Antihypertensive agents Blood pressure <130/80 or 125/75 mmHg  
Strict glycemic control A1c <7%  
Statins LDL cholesterol ≤100 mg/dl  
Acetyl salicylic acid Thrombosis prevention  
Smoking cessation Prevention of atherosclerosis progression  
InterventionGoal
MicroalbuminuricMacroalbuminuric
ACE inhibitor and/or ARB and low-protein diet (0.6–0.8 g · kg wt−1 · day−1 Reduction of albuminuria or reversion to normoalbuminuria Proteinuria as low as possible or <0.5 g/24-h and 
 GFR stabilization GFR decline <2 ml · min−1 · year−1 
Antihypertensive agents Blood pressure <130/80 or 125/75 mmHg  
Strict glycemic control A1c <7%  
Statins LDL cholesterol ≤100 mg/dl  
Acetyl salicylic acid Thrombosis prevention  
Smoking cessation Prevention of atherosclerosis progression  

* Low-protein diet: efficacy not proven in long-term studies in microalbuminuric patients.

Goal: 125/75 mmHg with increased serum creatinine and proteinuria >1.0 g/24-h.

LDL cholesterol <70 mg/dl in the presence of cardiovascular disease.

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