What is diabetic nephropathy

What is diabetic nephropathy, how to control? Diabetic nephropathy is commonly referred to as diabetic microangiopathy caused by diabetes - diabetic glomerulosclerosis, diabetic renal arteriosclerosis and pyelonephritis. The main feature of the lesion is glomerular (capillary plexus within the kidneys) localized or diffuse sclerosis. Glomerular sclerosis is mainly caused by long-term high blood sugar to the glomerular basement membrane on the glomerular glycoprotein and glycosylated protein increased basement membrane thickening, increased permeability, and hypertension, autoimmune, genetic, etc. factor. Thus, the occurrence and development of diabetic nephropathy and diabetes control is good or bad to the length of the course of disease is closely related to clinical research found that effective control of diabetes can stop or delay the occurrence of diabetic nephropathy. At present, diabetic nephropathy is still one of the most serious complications of diabetes, diabetes is one of the most important causes of death.

 According to clinical manifestations of diabetic nephropathy can be divided into: common in patients with a history of more than 10 years, is the main cause of death in type 1 diabetes is divided into five: Ⅰ: increased glomerular filtration rate and renal volume increased to feature. This initial lesion is consistent with hyperglycemia, but is reversible and can be restored by insulin therapy, but does not necessarily completely restore normal glomerular hypertrophy leading to increased filtration.

Ⅱ period: the urinary albumin excretion rate is normal but the glomerular structure has been changed. This period of urinary albumin excretion rate (UAE) normal (<20μg / min or <30mg / 24h), UAE increased after exercise rest after rest. Glomerular capillary basement membrane (GBM) thickening and increased mesangial matrix, GFR more than normal and consistent with the blood glucose levels, GFR> 150mL / min patients with glycated hemoglobin often > 9.5%. GFR> 150mL / min and UAE> 30μg / min after the patients more likely to develop clinical diabetic nephropathy. Diabetic renal damage in patients with stage Ⅰ, Ⅱ more normal blood pressure. Ⅰ, Ⅱ GFR patients increased, UAE normal, so the two can not be called diabetic nephropathy protein filtration stage Ⅲ: also known as early diabetic nephropathy. Urinary albumin excretion rate of 20 ~ 200μg / min, the patient's blood pressure increased slightly, began to appear abandoned glomerular. Ⅳ period: clinical diabetic nephropathy or dominant diabetic nephropathy. This phase is characterized by massive albuminuria (greater than 3.5 grams per day), edema and hypertension. Diabetic nephropathy is more serious edema, poor response to diuretics. Stage V: end-stage renal failure. Diabetic patients once the persistent urinary protein development for clinical diabetic nephropathy, due to extensive glomerular basement membrane thickening, glomerular capillary luminal stenosis and more glomerular waste, renal filtration function decreased, Leading to renal failure. The progress of diabetic nephropathy in each patient is different, and some patients with mild proteinuria sustainable for many years, while renal function has remained normal. Some patients with minimal proteinuria, but soon developed into severe proteinuria (≥ 3 to 5 g / day) such patients with poor prognosis.

 Treatment of diabetic nephropathy principles: ① strict control of blood sugar, blood sugar as close to normal levels as possible to prevent and delay the occurrence of diabetic nephropathy; ② delay the rate of renal dysfunction; ③ dialysis treatment and kidney transplantation. Prevention and treatment of diabetic nephropathy: 1. Strict control of blood sugar, before the emergence of clinical diabetic nephropathy, that is, early in the diabetes, insulin pump or subcutaneous insulin injections to strictly control diabetes, so that blood sugar remained normal, can delay or even prevent diabetes The occurrence and development of nephropathy, reduce the increased glomerular filtration rate and improve microalbuminuria. Other complications are also beneficial. According to the DCCT study, T1DM with intensive insulin therapy, the incidence of diabetic nephropathy decreased by 35 %% - 55 %%. Has been developed to clinical diabetic nephropathy, there are significant proteinuria, blood glucose control to help the development of its disease smaller. After the emergence of clinical diabetic nephropathy, hypoglycemic drugs should generally use insulin. 2. Control of high blood pressure, high blood pressure will promote the development of renal failure, effective antihypertensive treatment can slow down the rate of glomerular filtration rate, reduce urinary albumin excretion. Angiotensin converting enzyme inhibitors or angiotensin Ⅱ receptor antagonists can be used as the drug of choice, often in combination with other antihypertensive drugs. Other antihypertensive agents such as calcium antagonists, diuretics, beta-blockers, methyldopa, clonidine, etc. are also effective. Diabetic patients with blood pressure ≥ 130 / 80mmHg should use antihypertensive drugs, should be controlled at 130 / / 80mmHg the following. Treatment with antihypertensive drugs, the relatively healthy glomerular glomerular capillary pressure drop and continue to survive, but has been completely blocked the glomerular obstruction, water can not be filtered, the protein can not leak. It was observed that blood pressure decreased from 160 / 95mmHg to 135/85-mmHg, urinary protein excretion was significantly reduced glomerular filtration rate decreased from lml / / min · month to 0.35ml / / min · month . Diabetic nephropathy patients also significantly longer survival, antihypertensive treatment 10 years before the cumulative mortality rate of 50 %% - 70 %%, after treatment down to 18 %%. Antihypertensive therapy is also beneficial for diabetic retinopathy. 3. Diabetic nephropathy has occurred in patients with restricted protein intake, an appropriate diet to reduce the amount of protein (0.8 / kg · d) can reduce glomerular pressure, reduce high filtration and reduce proteinuria. On the contrary, to high-protein diet will aggravate glomerular histological lesions. Renal dysfunction has occurred should limit the intake of protein, and should eat essential amino acids with high protein. 4. Patients with advanced dialysis and renal transplantation can be implemented, once the emergence of renal failure, dialysis and kidney transplantation is the only effective way. Kidney transplantation is the best way to treat diabetes uremia, better than dialysis. Patients> 65 years old are poorly transplanted. 5. Attention to personal hygiene to prevent the occurrence of urinary tract infections. 6. Avoid the use of drugs harmful to the kidneys.