1.What is diabetic nephropathy?
Generalized diabetic nephropathy pathological changes include infectious pathological changes and vascular pathological changes. infectious pathological changes include nephropyelitis and necrosis of renal papillae. vascular pathological changes include microangiopathy and macroangiopathy, macroangiopathy is glomerular sclerosis, it divide into tuberous, exudative and diffuse, the three type can merge exist, above all, the most common is nodositas glomerular sclerosis, we often talk about diabetic nephropathy, that’s glomerular sclerosis. 2.What’s the clinical manifestation of diabetic nephropathy?
1) glomerular filtration rate increase
That’s the most early functionality changing
Protein is the mainly symptoms of diabetic nephropathy. normal person urine albumin displacement is 1.1~21.9 μg//min. diabetic nephropathy symptoms is microalbuminuria at early stage, albumin displacement is 20~200μg//min (30-300mg//24h ),that’s the main feature of diabetic nephropathy at early stage, it predictable the develop of diabetic nephropathy and has relate to prognosis. With the development of the disease, urinary albumin displacement increase gradually, When urine albumin discharge rate more than 200μg//min, the urinary total protein discharge is about 0.5 g / 24 h, at this time we called clinical diabetic nephropathy, Most of the patients with urinary protein discharge rate < 1 g / 24 h, rarely more than 5 g / 24 h, start urine protein excretion is intermittent, later become sustainable. The more urine protein discharge rate, the more disease condition serious and the speed of glomerular filtration rate reduce more fast. After 5-20 years later, most of patients appear continuity proteinuria develop to terminal stage renal failure.
3) nephrotic syndrome
About 10% patients with diabetic nephropathy show nephrotic syndrome at some stage. Urine protein >3g//24h, serum albumin reduce, edema, hypercholesterolemia,most of patients enter into renal insufficiency in a short period and bad prognosis.
4)high blood pressure
High blood pressure is the obvious manifestation of diabetic nephropathy at end stage. However, research find that before patients with diabetic appear kidney disease, the blood pressure already tend to increase, high blood pressure also promote kidney disease develop, patients with diabetic nephropathy and high blood pressure often appear renal failure in a short time, so effective treatment of reduce high blood pressure can delay kidney disease develop and extend patients life.
5) renal insufficiency
In clinic, Diabetic Nephropathy often appear after duration of diabetes 15years later. If appear proteinuria obviously, glomerular filtration rate will reduce gradually, every month drop about LML / / min in average, 5-20 years later enter end stage renal insufficiency, most of young patients die of uremic, most of old patients die of coronary heart disease, myocardial infarction, only 25% die of uremic.
Patients appear diabetic nephropathy, that’s mean diabetes mellitus already develop to end stage, other complication is common too, such as more than 95% patients have diabetic retinopathy, parts of patients go blind, cardiovascular disease, and neuropathy are more serious.
3.Treatment of diabetic nephropathy
1. strict control blood sugar
At the early stage of diabetic nephropathy, take insulin pump or repeatedly subcutaneous injection insulin strict control blood sugar, keep blood sugar normal, it can delay even prevent diabetic nephropathy appear and develop, reduce increasing glomerular filtration rate and improve microalbuminuria, it also has good for other complication
2.control high blood pressure
High blood pressure can promote renal failure develop, effective depressurization treatment can slower the speed of glomerular filtration rate reduce. Reduce urinary albumin discharge rate, the first choice medicine is angiotensin converting enzyme and angiotensin Ⅱ receptor antagonist, it often need unite other hypotensive medicine, such as calcium channel blockers, diuretics, β-blockers, methyldopa, clonidine and so on. Patients with diabetic need take hypotensive drugs when blood pressure≥130//80mmHg, it should be control under 130//80mmHg. When take antihypertensive drugs to treatment,because of glomerular capillary pressure drop the relatively healthy glomeruli will still alive, however, damaged glomerular will soon completely blocking, water can’t filtration, protein also can’t leakage, somebody research that, when blood pressure from 160//95mmHg reduce to 135//85-mmHg, urine protein discharge rate reduce obviously, the speed of glomerular filtration rate reduce from lml//min•month to 0.35ml//min•month, patients with diabetic nephropathy lifetime extend obviously. before antihypertensive therapy decade accumulative total mortality is 50%-70%, after antihypertensive therapy decade accumulative total mortality is 18%, antihypertensive therapy also good for diabetic retinopathy.
3.limit protein intake
appropriate reduce protein quantity of food, it can reduce the inner pressure of glomerulus, lighten high filtration and reduce protein, on contrary, high protein food will exacerbation glomerular histologic lesions, the patients who already appear renal insufficiency should be more limit intake protein and eat contain essential amino-acid food.
4. Dialysis and kidney transplant
if patients appear renal failure, dialysis and kidney transplant is the only efficient way, Renal transplantation is the best way to treat diabetes uremia, better than dialysis treatment. Age > 65 - year - old patients with transplant effect is poor.
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