However, the lowest target of BP is unknown and further investigations are needed to address this issue. Bibliography 1. Mauer M, et al. N Engl J Med.

2009;361:40–50. (Level 2)   2. Ravid M, et al. Ann Intern Med. 1998;128:982–8. (Level 2)   3. Makino H, et al. Hypertens Res. 2008;31:657–64. (Level 2)   4. Jerums G, et al. Diabet Med. 2004;21:1192–9. (Level 2)   5. de Galan BE, et al. J Am Soc Nephrol. 2009;20:883–92. (Level 2)   6. Persson F, et al. Clin J Am Soc Nephrol. 2011;6:1025–31. (Level 2)   7. Cooper-DeHoff RM, et al. JAMA. 2010;304:61–8. (Level 3)   Is a low protein diet PD0332991 recommended to LDN-193189 suppress the progression of diabetic nephropathy? In the development of progressive renal disease, including diabetic nephropathy, the activity of the underlying disease is important as a basic factor (blood glucose level in the case of diabetic nephropathy). In addition, hemodynamic and metabolic abnormalities are factors affecting the progression of renal injuries, and protein intake affects these factors.

From the results of animal experiments, protein restriction has been found to exert a renoprotective effect through the improvement of glomerular hypertrophy, glomerular capillary resistance, and glomerular hypertension by improving abnormal metabolic factors and hemodynamics. The effect on a low protein diet on suppressing the progression of diabetic nephropathy (especially in find more type 2 diabetes) is not clear. However, protein restriction can be expected to provide a renoprotective effect in diabetic nephropathy. Therefore, at

the G3 stage of CKD, protein restriction of 0.8–1.0 g/kg standard body weight/day is recommended, and at the G4 stage: 0.6–0.8 g/kg standard body weight/day is recommended. The accumulation of additional evidence is required to make a recommendation on an advanced low protein diet (<0.5 g/kg standard body weight/day) and currently this should be determined by each individual patient’s risk, pathophysiology Vitamin B12 and adherence. Bibliography 1. Ciavarella A, et al. Diabetes Care. 1987;10:407–13. (Level 2)   2. Walker JD, et al. Lancet. 1989;2:1411–5. (Level 4)   3. Zeller K, et al. N Engl J Med. 1991;324:78–84. (Level 2)   4. Pedrini MT, et al. Ann Intern Med. 1996;124:627–32. (Level 1)   5. Kasiske BL, et al. Am J Kidney Dis. 1998;31:954–61. (Level 1)   6. Pan Y, et al. Am J Clin Nutr. 2008;88:660–6. (Level 1)   7. Koya D, et al. Diabetologia. 2009;52:2037–45. (Level 2)   Is multifactorial intensive therapy recommended for suppressing the onset and progression of diabetic nephropathy? The Steno-2 Study showed the effect of multifactorial intensive therapy, including blood glucose, blood pressure using RAS inhibitors and lipid control on the progression of nephropathy in microalbuminuric patients with type 2 diabetes.