Post Date December, 03 2023
Because patients with diabetes also have many complications such as cardiovascular disease, retinopathy, digestive system disease, etc., the cardiopulmonary function and nutritional status of patients with diabetes nephropathy are worse than those with other diseases, and they will dialysis earlier than those with other kidney diseases.
Therefore, every general practitioner should understand the basic knowledge of diabetes nephropathy, and remind patients to actively prevent and early detect diabetes nephropathy.
Case Introduction
Lao Wang, 56 years old, was diagnosed with diabetes five years ago. Although the doctor warned him to control his diet and blood sugar, he still eats and drinks as he pleases. He smokes a pack a day and seldom gets active. As time passed, Lao Wang became more and more uncomfortable, not only malaise, dry mouth, but also blurred vision, numbness of hands and feet, asthma and other discomfort, and his weight dropped by 20 kg in a year. Recently, Lao Wang was found to have uremia.
Case Analysis
It is well known that nephritis can cause uremia, but many people do not know that diabetes can also cause uremia. With the improvement of living standards, more and more patients like Lao Wang "eat" diabetes nephropathy. Once diabetes nephropathy occurs, the renal function of the patient will inevitably decline.
Diabetes nephropathy is a common complication of diabetes and one of the manifestations of systemic microvascular disease in diabetes. The kidney is mainly composed of capillary groups, and hyperglycemia itself can damage capillaries and increase Vascular permeability. When substances in the blood filter through the kidney to form urine, they damage the kidney and cause diabetes nephropathy. Most patients with diabetes have metabolic disorders, such as hypertension, hyperlipidemia, etc., which is easy to cause vascular sclerosis. In addition, genetic and metabolic disorders have a certain effect on the occurrence of diabetes nephropathy.
Eight factors aggravate diabetes nephropathy
1. High protein diet: A high protein diet can increase the burden on the kidneys, exacerbate proteinuria, and form a vicious cycle. Therefore, diabetes patients should not consume more than 40g of protein every day.
2. Hyperglycemia: Elevated blood sugar is the main cause of kidney disease. Persistent high blood sugar can form glomerular hyperperfusion and hyperfiltration, causing damage to the glomerular mesangium, basement membrane, capillary endothelium, etc., further damaging the glomerulus and renal tubules, ultimately causing glomerular and glomerular arteriosclerosis, causing nephron damage, and causing renal dysfunction.
3. Hypertension: Hypertension increases renal vascular resistance, reduces renal blood flow, increases renal pressure, etc., leading to proteinuria, glomerulosclerosis, and renal failure. Diabetes and hypertension often coexist, will form a vicious circle, diabetes patients with hypertension are more prone to kidney damage.
4. Hyperlipidemia: In diabetes patients, dyslipidemia is very common. The latter can promote glomerulosclerosis and accelerate the progress of diabetes nephropathy.
5. Increased blood viscosity and microcirculatory disorder: diabetes can cause microvascular disease, often accompanied by microcirculatory disorder, which makes the blood easy to coagulate and form thrombus. If there is a blood clot in the microcirculation of the kidney, the nephron will experience ischemia and hypoxia, resulting in an increase in urine protein and a decrease in renal function.
6. Infection: Colds, urinary tract infections, and viral and bacterial infections such as pneumonia can all exacerbate kidney damage.
7. Medications: When suffering from kidney disease, many medications need to be reduced in dosage or banned. Abuse of medications can worsen kidney damage, and medication must be taken according to medical advice.
8. Others: The occurrence of diabetes nephropathy is related to age, course of disease, genetic factors, environmental factors, smoking and other factors.
Eight manifestations suggest diabetes nephropathy
1. Proteinuria: clinically, the only early manifestation of diabetes nephropathy is proteinuria, which starts intermittently and gradually develops into continuity. Early micro albuminuria, ordinary urine routine test can not come out. Once urine protein is found in routine urine test, diabetes nephropathy has developed to the middle stage. Early use of radioimmunoassay to measure albumin excretion rate, with results ranging from 20 to 200 μ G/min, indicating that it is the early stage of diabetes nephropathy.
2. Edema: diabetes nephropathy usually has no edema at the early stage, or only has eyelid edema in the morning. A few patients may have mild edema before the decrease in plasma protein. If there is a large amount of proteinuria, low plasma protein, and worsening edema, it is often a manifestation of disease progression to the late stage.
3. Hypertension: High blood pressure is not only an early sign of diabetes nephropathy, but also an important factor in aggravating diabetes nephropathy.
4. Renal failure: There are great differences in the progress of diabetes nephropathy. Some patients have mild proteinuria that can last for many years, but their kidney function is normal. Some patients have low urinary protein and can rapidly develop nephrotic syndrome, gradually deteriorating kidney function, and ultimately developing uremia.
5. Increased nocturia: If there is an increase in the frequency or volume of urination at night, it indicates that the kidneys may be damaged.
6. Anemia: It is a common manifestation of combined kidney damage.
7. Retinopathy: almost 100% of patients with severe diabetes nephropathy have retinopathy. It can cause visual impairment or even blindness.
8. Heart failure, myocardial infarction and peripheral neuritis: common complications of diabetes nephropathy.
8 measures to prevent diabetes nephropathy
Because of the irreversibility of diabetes nephropathy and the difficulty of treatment, it is of more positive significance to prevent diabetes nephropathy. The main measures for prevention are:
1. Control blood sugar: Unstable blood sugar levels or high blood sugar levels still cause chronic damage to the most important organs of the human body, such as the heart, brain, kidneys, and eyes, promoting the occurrence of complications, especially causing early hidden and irreversible damage to the kidneys. The key to reducing diabetes nephropathy is to strictly control blood sugar to reach the standard. It should be emphasized that for patients with poor control of dietary therapy, oral hypoglycemic drugs, or existing renal dysfunction, timely insulin treatment must be used.
2. Control of hypertension: most patients with diabetes are accompanied by hypertension, which has doubled the burden on the kidney. Hypertension can accelerate the progress and deterioration of diabetes nephropathy. Therefore, patients with diabetes nephropathy should pay more attention to the control of blood pressure. For those with proteinuria ≤ 500mg/d or above, blood pressure should be controlled within 130/80mmHg; For those with proteinuria ≥ 500mg/d, blood pressure should be controlled at 125/75mmHg.
3. Reasonable diet and limited protein intake: diabetes patients mainly take light diet. Take in sufficient vitamins and trace elements. Especially vitamin B, vitamin C, zinc, calcium, iron, etc., have a protective effect on the kidneys. Protein intake should be limited at the early stage of diabetes nephropathy, with 30~50g per day as appropriate, and high-quality animal protein should be selected, such as chicken, eggs, milk and fish. It is not advisable to use plant proteins as their low bioavailability can actually increase the burden on the kidneys. Diabetes patients should drink more water and keep the daily water consumption and urine volume at about 1500~2000mL to facilitate the discharge of metabolic wastes. But the intake of potassium containing beverages and fruits should be controlled.
4. Regular monitoring: The blood sugar level changes with the environmental season, and also fluctuates with the drug sensitivity. It is necessary for diabetes patients to regularly monitor blood sugar, urine protein and blood pressure levels.
5. Once type 2 diabetes is diagnosed, renal function should be checked: type 1 diabetes is relatively easy to monitor the time when patients progress to diabetes nephropathy because of its obvious onset symptoms, namely, excessive drinking, eating, urination and weight loss. However, type 2 diabetes, which is easy to be suffered by obese people, is difficult to define the time of onset and the potential time of progression of the disease because the onset symptoms are not obvious. Therefore, once it is determined as type 2 diabetes, urinary protein test should be carried out immediately, and renal function test should be carried out every year during physical examination thereafter.
6. Avoid urinary system infection: recurrent urinary system infection can aggravate diabetes nephropathy, and should be treated in time in case of infection.
7. Avoid using drugs that damage the kidney: such as gentamicin, streptomycin, etc. Use painkillers carefully, and avoid angiography and nephrography.
8. Avoid strenuous activities: Patients with diabetes nephropathy should avoid strenuous activities to prevent aggravating the disease.
In a word, the occurrence of diabetes nephropathy, like other chronic complications, is caused by a combination of multiple reasons. Once diabetes nephropathy is formed, treatment is difficult, so early prevention, early diagnosis and treatment are important.
