Diabetic Nephropathy Treatment in Malaysia

• Clinical assessment:
  • Medical and Diabetes Assessment: A detailed medical history is taken to assess diabetes duration and control, blood-pressure history, cardiovascular disease, medications, and other conditions that may affect kidney function. The physical exam may include assessment of blood pressure, fluid retention, swelling, and other complications of diabetes.
  • Kidney Function and Urine Assessment: Blood tests commonly include serum creatinine and estimated GFR, while urine testing includes the urine albumin-to-creatinine ratio (UACR) and urinalysis.
  • Metabolic and Laboratory Assessment: Additional testing may include blood glucose, HbA1c, electrolytes, blood urea nitrogen, albumin, calcium, phosphorus and complete blood count.
  • Assessment for Other Kidney Diseases: If findings are atypical, rapidly progressive, or inconsistent with diabetic kidney disease, doctors may investigate other causes of CKD and, when clinically appropriate, consider additional blood tests or a kidney biopsy.
• Imaging Tests:
  • Kidney Ultrasound: Helps assess kidney size, structure and possible urinary tract obstruction or other structural abnormalities.
  • Doppler Ultrasound: May be used to evaluate renal blood flow when vascular abnormalities are suspected.
  • CT or MRI: May be considered when structural abnormalities, stones, masses or other complications require further evaluation.
  • Kidney Biopsy: Not routinely required for typical diabetic kidney disease but may be considered when another kidney disorder is suspected or the clinical presentation is unusual.

MediRehab (a chain of Rehab centres, part of MediGence) provides comprehensive tele-rehabilitation services designed to support Diabetic Nephropathy patients in Malaysia. These services include:

• Exercise and Physical Activity: Individualised physical activity can help maintain strength, mobility, cardiovascular health and diabetes control.
• Weight Management: Structured nutrition and physical-activity programmes may help people achieve or maintain a healthy weight when appropriate.
• Management of Functional Complications: Patients with advanced CKD, weakness, fatigue, neuropathy or other complications may benefit from physiotherapy and occupational therapy.
• Long-Term Lifestyle and Self-Management Support: Education regarding medication adherence, blood glucose monitoring, blood-pressure management, smoking cessation and regular follow-up can support long-term kidney health.

• Medicines for diabetic nephropathy aim to control blood glucose and blood pressure, reduce albuminuria and slow kidney disease progression. ACE inhibitors or ARBs are commonly used for people with diabetes, hypertension and albuminuria. Selected patients with type 2 diabetes, CKD and albuminuria may also receive finerenone, with kidney function and potassium monitored during treatment. Other medicines may be prescribed for anemia, fluid retention, cholesterol abnormalities, diabetes or other CKD-related complications.