Diabetes itself is not terrible, terrible is caused by its various complications. Among the many complications of diabetes, the most serious when the number of diabetic nephropathy. If the patient's blood sugar control is not good, 10 to 20 years after about 50% of patients with renal damage, severe cases may even develop uremia.According to statistics, diabetic nephropathy accounts for about 1/3 of all diabetic patients; diabetic patients with uremia than non-diabetic patients increased 17 times; in dialysis treatment of uremic patients, 2/5 is caused by diabetes.
oneWhat are the risk factors for diabetic nephropathy?The risk factors of diabetes mellitus are hyperglycemia, hypertension, hyperlipidemia, high blood viscosity, high protein diet (especially vegetable protein), smoking, duration of disease, genetic susceptibility and so on. Long-term chronic hyperglycemia and glomerular microvessels And the basement membrane of the protein in the non-enzymatic reaction, the formation of glycated protein, is the leading cause of the disease, and hypertension is another important risk factor.
TwoThe stage of diabetic nephropathyDiabetic nephropathy onset attack, early often without any symptoms, with the course of the extension and gradually increased, according to the development process from light to heavy can be divided into five:1 period for the "glomerular hyperfiltration period", this period mainly for the glomerular filtration rate increased, the kidney volume increases, but the glomerular structure without pathological changes;2 for the "intermittent microalbuminuria", that is, after exercise can occur in the urine albumin, but after rest can return to normal, glomerular structure may have mild abnormalities;3 for the "early diabetic nephropathy", the main feature is persistent microalbuminuria, 24-hour urine protein in the 30 to 300 mg, urinary protein excretion rate of 20 to 200 micrograms / min;4 is "clinical diabetic nephropathy", a large number of proteinuria, urinary protein> 0.5 g / 24 hours, urinary protein excretion rate> 200 micrograms / min, accompanied by edema, hypertension and so on;5 for the "renal failure", proteinuria, edema, hypertension can be further aggravated anemia, electrolyte imbalance, acidosis, nausea, vomiting, renal bone malnutrition, and ultimately into the uremic period, must be kidney dialysis Or kidney transplant.
threeEarly detection of cluesWhether it is a doctor or diabetes first in the ideological to attach great importance to once diagnosed with diabetes, be sure to check the renal function, in particular, can reflect the early indicators of renal damage (such as kidney B ultrasound, glomerular filtration rate, Albumin quantitative and excretion rate determination, etc.), if normal, after every six months to review once a year.Early detection of diabetic nephropathy is very important, such as in the early stage of diabetic nephropathy (1 to 3) to give a positive and reasonable treatment can block the disease development or even completely back to normal, in fact, when the patient edema, clinical proteinuria, The condition is often not early, early diagnosis mainly to see three aspects:First, check the glomerular filtration rate;The second is to check urine microalbumin quantitative;Third, whether the urine osmolality is reduced, mainly to check the water for 12 hours of urine osmotic pressure.In addition can also be combined with fundus examination results, because diabetic nephropathy and diabetic retinopathy belong to the same microvascular disease, both often accompanied by the occurrence.
Understanding Kidney Disease
FourPrevention and treatment of diabetic nephropathy five magic weapon
1. To strictly control blood sugar.Hyperglycemia is an important factor in causing kidney damage, therefore, must be long-term control of blood sugar at the desired level. Fasting blood glucose <6.1mmol / L, two hours after the meal blood glucose <8.0mmol / L, glycosylated hemoglobin <6%.Through strict control of blood sugar, can greatly reduce the chance of kidney disease, but also can make most of the early diabetic nephropathy (microalbuminuria) to reverse or delay the progression of the disease.In the early diabetic nephropathy, can be used mainly by the bile duct excretion of hypoglycemic drugs, such as Connaught and the dragon, sugar is appropriate; when renal insufficiency, should be given insulin treatment.
2. To strictly control blood pressure.Hemodynamic abnormalities can lead to glomerular sclerosis, hypertension and hyperglycemia compared to the former diabetic kidney damage has gone. Strict control of blood pressure, can significantly reduce the protein in patients with diabetic nephropathy, delay the process of renal damage. Diabetic blood pressure requirements in the control of 120 / 80mmHg the following drugs preferred angiotensin converting enzyme inhibitors (such as Lotensin), these drugs in addition to antihypertensive effect, the protection of the kidney is also very useful. A small number of patients after taking dry cough, this time can be used for angiotensin Ⅱ receptor antagonist (such as the generation of literature).
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3. To reduce blood lipids and blood viscosity.Dyslipidemia is also one of the risk factors of renal damage, therefore, should be lipid (especially low-density lipoprotein cholesterol) in the normal range.
4. To properly limit the intake of protein.High protein diet can increase the glomerular perfusion pressure and filtration rate, so that urinary protein excretion increased, therefore, in order to reduce the burden on the kidneys in the early stage of diabetic nephropathy that should limit protein intake, protein intake in the diet To 0.8 g / kg body weight per day is appropriateThe main choice of high quality animal protein (such as chicken, fish, lean meat, eggs, milk) to supply more essential amino acids. Plant protein (such as tofu, soy milk, etc.) will increase the burden on the kidneys, while the body can not be fully utilized, should be appropriate restrictions. If edema, should also limit salt intake (5 grams per day).
5. Also pay attention to quit smoking, to avoid urinary tract infection.Early diabetic nephropathy (ie, the first three) after active treatment is completely reversible. But because of the onset of diabetic nephropathy, almost no symptoms in the early stages of the disease, and thus easily overlooked by the patient; and once the face and lower extremity edema, a large number of proteinuria, kidney disease has often developed to irreversible stage, the loss of the best treatment opportunity.
Therefore, once diagnosed with diabetes, with or without edema, should be routinely do urinary microalbumin (note: not normal urine) and renal function tests to facilitate the early detection and timely treatment of diabetic nephropathy
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