What is diabetic nephropathy
Diabetics must pay attention to kidney function, because long-term poorly controlled blood sugar can easily lead to impaired kidney function. Diabetic nephropathy is kidney damage caused by long-term diabetes.
The kidney damage caused by diabetes is mainly diabetic glomerulosclerosis, and its clinical manifestations are mainly proteinuria, edema, hypertension, and azotemia.
How is diabetic nephropathy caused?
1, hypertension can lead to and aggravate diabetic nephropathy, diabetic patients blood sugar control will appear lipid metabolism disorders, atherosclerosis, etc., these patients if there is hypertension, can be found out urine trace protein, indicating that kidney damage is common.
2, the impact of hyperglycemia itself: the main damage of diabetes is the tiny arteries of the whole body, long-term hyperglycemia can lead to increased capillary permeability, capillary basement membrane damage, glomerulosclerosis and renal tissue atrophy, so that kidney damage occurs, serious renal failure uremia.
3, the impact of dietary factors: diabetes to control blood sugar, limit the intake of carbohydrates is necessary, at this time the diet is often based on high-protein fiber food supply, so it is easy to appear protein breakdown products and phosphorus overload and accumulation, which in turn aggravates kidney damage.
How to determine if you have diabetic nephropathy?
1. Determination of microalbuminuria: two microalbuminuria within 6 months in 20 to 200 microgram minutes, excluding other factors and heart failure, obstruction and other reasons can be diagnosed as furunculosis nephropathy. Therefore, this is one of the diagnostic projects for diabetic nephropathy.
2. Auxiliary examination: see if the kidney is enlarged compared with normal people of the same age under color ultrasound or CT.
3. Provocative test: under a certain exercise load, normal people do not appear proteinuria, while early diabetic patients can have proteinuria. It can also be seen that urinary-N-acetate-B-glucosamine transferase (NAG), T-H glycoprotein, and urine B2-microglobulin detection are all indicators of early diagnosis of diabetic nephropathy.
Manifestations and stages of diabetic nephropathy
Diabetic renal damage is divided into 5 stages, type 1 progresses about once every 5 years, type 2 diabetes renal damage progresses faster than type 1 diabetes, about every 3 to 4 years progression, may be associated with type 2 diabetes more in middle and older people and more hypertension and hyperlipidemia.
1. Stage I, expired glomerular hyperfiltration: the glomerular filtration rate increases and the volume of the kidney increases. Phase I is mostly reversible after insulin therapy, but it does not necessarily return to normal completely.
2. Stage II. and renal damage without clinical manifestations, the urinary albumin excretion rate in this period is normal, and the urine albumin is increased after exercise, and can be restored after rest. In this stage, the glomeruli have undergone structural changes, the glomerular filtration rate is much higher than normal, and the patient's glycosylated hemoglobin is often greater than 9.5%. Stage I., II. patients with high glomerular filtration and normal urinary albumin, so the second stage can not be called diabetic nephropathy, but the kidneys have changed, if not treated in time, then the kidney damage can not be recovered.
3. Stage III. and early diabetic nephropathy: persistent microalbuminuria, but the urine routine test protein is still negative. The glomerular filtration rate in patients at this stage is generally normal, but the blood pressure begins to rise, and the renal lesions in this period are irreversible and the function of the glomeruli begins to decline.
4. Stage IV. Clinical diabetic nephropathy or dominant diabetic nephropathy: it is a large amount of albuminuria, edema and hypertension, diabetic nephropathy edema is more serious, and the response to diuretic drugs is poor.
5. Stage V. and end-stage renal failure: extensive thickening of the glomerular basal membrane, progressive narrowing of the glomerular capillary cavity and more glomerular abandonment, progressive decline in renal filtration function, resulting in renal failure.
What are the symptoms of early diabetic nephropathy
1. Kidney enlargement: at the beginning of diabetes, there will be renal hypertrophy and high glomerular filtration, and proteinuria continues to increase, but at this stage, insulin can be used in time to treat diseases, and kidney function can be restored.
2. Increased urine output: Diabetic patients begin to have more than three phenomena, that is, eat more, drink more, polyuria, and the daily increase in urine output exceeds that of normal people. This is because in the early stages, the glomerular filtration rate increases, the amount of urine also increases, and active treatment at this time can stop the progression of diabetic nephropathy.
3. Edema: there is generally no edema in the early stage of diabetic nephropathy, and a small number of patients may have mild edema before the plasma protein is reduced, and when the urine protein exceeds 3 grams in 24 hours, the edema will appear. Patients with rapidly developing kidney disease will have significant generalized edema.
4, protein in the urine: this is the main manifestation of diabetic nephropathy, the phenomenon of urine protein is intermittent in the early stage, let diabetics check the urine protein after exercise, after exercise, or the urine protein after exercise is further increased, called exercise proteinuria, which is the early manifestation of kidney disease and needs to be actively treated.
5. Recurrent pyelonephritis: due to a large amount of glucose in the urine, bacteria are easy to grow and multiply, and the patient's resistance is low, making pyelonephritis recurrent, so it is difficult to completely cure.
6, urine protein: after exercise, urine protein is often an early manifestation, if there is protein in the daily urine, and the urine protein exceeds 3 grams / day, this is more serious, generally not the early performance.
7. Nephrotic syndrome: the increase in urine protein reaches more than 3 grams per day, accompanied by hypoproteinemia, obvious edema and hyperlipoproteinemia, which is the manifestation of nephrotic syndrome, and the development to this extent is not early, if not actively treated will soon enter the terminal stage.
8. Diabetic retinopathy: Retinopathy is not a clinical manifestation of nephropathy, it is a typical complication of diabetes, but diabetic nephropathy exists at the same time.
Daily considerations for diabetic nephropathy
1. Rest: When the symptoms are serious, it is necessary to rest absolutely in bed, and the remission period should be combined with work and leisure to avoid labor and fatigue. When your condition is stable and improving, you can participate in some work within your ability.
2, mental health: long-term diabetic nephropathy patients, psychology is often affected, in the active treatment of diseases at the same time, do a good job of long-term coexistence with the disease psychological preparation.
3. Control the diet: to the period of diabetic nephropathy, it is necessary to comply with a strict diabetic diet, low-carbon water, and eat more foods containing vitamins and proteins. Calories for three meals are distributed according to 1/5, 2/5 and 2/5 of the morning, noon and evening.
4. Monitor and control blood sugar, prevent high blood sugar at the same time, but also be vigilant against low blood sugar.
5. Hypoglycemic drugs and insulin: Take hypoglycemic drugs or insulin regularly and quantitatively according to the doctor's instructions, pay attention to adverse reactions, regularly check in the hospital, and report the condition to your attending physician.
6. Prevention of infection: due to the poor resistance of diabetic patients, easy to infect, the skin of the whole body should be kept clean, bathe frequently, change underwear and underwear frequently, and keep the sheets clean. When climate change, it is necessary to increase or decrease clothes in time, and if there is a cold, it should be treated in time.