Figure 145

Nephrotic syndrome. Proteinuria in diabetic nephropathy typically progresses more than 3.5 g/day (nephrotic range), leading to hypoproteinemia, hyperlipidemia, and extracellular fluid accumulation (nephrotic syndrome). Management of a nephrotic diabetic patient includes minimizing protein loss using an angiotensin-converting enzyme inhibitor (ACEi) and promoting diuresis with a combination of loop diuretics (furosemide) and thiazide diuretics (metolazone). Distinction between congestive heart failure and nephrotic edema requires assessment of cardiac function. (From Herbert et at. [33] and Gault and Fernandez [34]; with permission.)

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