Diabetic nephropathy

Diabetic nephropathy is a diabetic microangiopathy important, and is one of the major causes of death for diabetes. In the course of more than 15 years in IDDM people will be 30% -40% in diabetic nephropathy; NIDDM in people occurred in 25% of diabetic nephropathy. Generalized diabetic kidney disease include diabetes combined with acute pyelonephritis and renal papillary necrosis, acute renal papillary necrosis relatively rare. Narrow diabetic nephropathy is caused by diabetes and renal glomerular capillary vascular sclerosis caused by the normal excretion and filtration reduction, which eventually led to renal failure.

[Causes]
Diabetic nephropathy is made up of different etiology and pathogenesis of insulin caused in absolute and relative shortage of sugar that protein and fat metabolism disorders, and chronic high blood sugar is the main clinical manifestations of systemic disease. Diabetes can damage the kidneys of these different channels can damage the structure of all involved kidneys, but only glomerular sclerosis and diabetes have a direct relationship, also known as diabetic nephropathy and diabetic microvascular complications systemic one. Diabetic patients kidney damage in the event of persistent proteinuria is often irreversible condition to the development of end-stage renal failure. Diabetic nephropathy has become diabetic patients leading causes of death.

[Clinical performance and staging]
Ⅰ period: increased glomerular filtration rate and renal volume increased features. This early lesions consistent with the high blood glucose levels, but reversible, after insulin treatment can be resumed, but may not be able to return fully to normal.
Ⅱ period: The period of normal urinary albumin excretion rate of glomerular but there has been structural change.
Ⅲ period: called early diabetic nephropathy. Urinary albumin excretion rate of 20 - 200 μ g / min, the patient’s blood pressure increased slightly, and began to glomerular abandoned.
Ⅳ period: Clinical diabetic nephropathy or overt diabetic nephropathy. This period is characterized by macroalbuminuria (more than 3.5 grams per day), edema and hypertension. Diabetic nephropathy more serious edema, poor response to diuretics.
Ⅴ period: end-stage renal failure. Diabetic patients in the event of persistent urinary protein for clinical development of diabetic nephropathy, as widely glomerular basement membrane thickening of the glomerular capillary cavity narrow and more abandoned glomerular kidney filtration function of the decline , resulting in renal failure.

[Treatment]
(A) medical treatment
1. Diabetes treatment:
(1) diet therapy: current advocates of early diabetic nephropathy that should limit the intake of protein (0.8 g / kg.d). To have edema and renal insufficiency patients, in addition to diet restrictions on the sodium intake, protein intake to be taken on the principle of streamlined (0.6 g / kg.d), if necessary, appropriate amino acid and plasma transfusion . Insulin can be guaranteed in the appropriate increase in carbohydrate intake to ensure adequate calories. Fat to use vegetable oil.
(2) drug treatment: oral hypoglycemic agent. For simple diet and oral hypoglycemic drug control has been poor and renal insufficiency patients using insulin should be as soon as possible. Insulin, blood glucose monitoring to timely adjust dosage.
2. Antihypertensive treatment:
Hypertension can accelerate the progress of diabetic nephropathy and deterioration to control the blood pressure level of diabetes than non-diabetic patients with hypertension lower diastolic blood pressure less than 75 mmHg. Should limit sodium intake, smoking, alcohol restrictions, reducing body weight and adequate exercise. First advocated more antihypertensive drug use of angiotensin-converting enzyme inhibitors, often combined with calcium antagonists, can be used as α1 receptor antagonist prazosin. Under appropriate conditions can be added using diuretics.

(B) dialysis treatment:
End-stage diabetic nephropathy patients can only receive dialysis treatment, there are two main ways: long-term hemodialysis and continuous ambulatory peritoneal dialysis. Recently the vast majority of end-stage patients with diabetic nephropathy to peritoneal dialysis, because it does not increase the heart load and stress, can better control of extracellular fluid volume and high blood pressure. Also intraperitoneal injection of insulin, convenient operation cost savings, but some long-term peritoneal dialysis patients absorb large amounts of glucose caused obesity and hyperlipidemia. On dialysis to the timing of earlier in the non-diabetic patients.

(C) renal or kidney pancreas transplantation:
Only a few patients can receive such treatment. Therefore diabetic nephropathy is the most fundamental measures to control diabetes, as far as possible to prevent the occurrence of diabetic nephropathy and development.
On the prevention and treatment of this disease, focusing on prevention, prevention lies in prevention, and correction of all risk factors, including blood glucose and blood pressure control, smoking cessation. In the stage of microalbuminuria, strict control of blood sugar can prevent the occurrence of nephropathy.

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