MSc Thesis: Diabetic Nephropathy, Medication and Proteinuria

This thesis examines diabetic nephropathy, a significant complication of diabetes, focusing on the management of proteinuria through various medication groups. The research includes a case-controlled trial conducted in the UK, involving patients with Type 2 Diabetes Nephropathy already on ACEi or ARBs with spironolactone. The study aims to identify additional treatment options for patients with persistent proteinuria and assess the feasibility of combining ACEi or ARBs with spironolactone. The results show that the combination of ACEi or ARB with spironolactone was well-tolerated by patients, with some improvement in ACR and no decline in GFR. The thesis covers the definition, classification, epidemiology, and pathophysiology of diabetes mellitus, including the impact of ethnicity and complications. A comprehensive literature review explores diabetic nephropathy risks, the role of the renin-angiotensin-aldosterone system, and the effects of different medication classes such as ACEi, ARBs, aldosterone antagonists, SGLT2 inhibitors, and GLP-1 analogues. The study concludes that spironolactone is a viable option for reducing proteinuria in patients on ACEi or ARB therapy, providing valuable insights into the management of diabetic nephropathy in primary care settings. The thesis provides detailed results, discussion and conclusion sections including the methodology of the study, statistical data and references.