Diagnosis and treatment of diabetic nephropathy

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(1) diagnosis of diabetic nephropathy:There are more than 5-10 years of diabetes in patients with varying degrees of proteinuria, and the pr

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(1) diagnosis of diabetic nephropathy:

There are more than 5-10 years of diabetes in patients with varying degrees of proteinuria, and the presence of diabetic retinopathy or other complications can be considered

Diabetic nephropathy diagnosis. It can be divided into 5 stages according to the course of diabetic nephropathy and the pathophysiology. Phase I: clinical manifestations. Phase III: persistent microalbuminuria: urinary albumin excretion rate (UAER) 20-200ug/min, blood pressure began to rise. Phase IV: clinical diabetic nephropathy, a large number of proteinuria (UAER> 200ug/min), blood pressure increased significantly, decreased renal function. Phase V: end stage renal failure requiring dialysis therapy.

(2) prevention and treatment of diabetic nephropathy

Prevention and treatment of diabetic nephropathy is the focus of active control of blood sugar, regular screening for diabetic nephropathy. The use of angiotensin converting enzyme inhibitors or angiotensin II receptor antagonists can delay the progression of diabetic nephropathy in diabetic nephropathy patients with microalbuminuria or proteinuria. For patients with end-stage renal disease (stage V), or difficult to resolve the excess capacity, high blood pressure, low protein diet lead to malnutrition and so on should start dialysis treatment.

Diet therapy: low salt, low fat diet is the diet principle of diabetic nephropathy, renal insufficiency patients should also limit the intake of dietary protein. Excessive protein intake can increase glomerular filtration and promote glomerular basement membrane thickening. Protein intake should be based on high biological protein, such as lean meat, beef, fish, eggs, etc.. Limit the intake of salt, cooking oil with vegetable oil as well. If the renal function is significantly abnormal, but also to limit the number of foods containing high potassium.

Physical exercise: according to the appropriate exercise. In the early stage of diabetic nephropathy, aerobic exercise with brisk walking can be carried out. Avoid prolonged exercise with high intensity and high blood pressure. If the occurrence of albuminuria should not be greater intensity of exercise therapy.

Control blood sugar: according to the patient's condition, under the guidance of doctors choose oral hypoglycemic drugs or insulin. There is a decline in renal function should not be used in the class of hypoglycemic drugs, so as to avoid lactic acidosis. For oral hypoglycemic drugs can not be a good control of blood glucose and renal function damage, should be treated with insulin. But for patients with end-stage renal disease due to insufficient attention to, and insulin inactivated loss, easy hypoglycemia, and because renal glucose threshold increased, even if the blood sugar level, but often negative urine glucose, blood glucose should be monitored frequently and therefore, in order to adjust the dose of insulin.

Blood pressure control: antihypertensive treatment should limit salt intake, start to lose weight, quit smoking wine. The control of blood pressure target value is less than 130/80mmHg, if the urine protein is more than 1 g / day, blood pressure should be controlled at or even below 125/75mmHg, the rate of renal function decline to slow down. Use of angiotensin converting enzyme inhibitors (ACEI) or angiotensin II receptor antagonists (ARB), not only can reduce the system of high blood pressure, but also can reduce urinary protein, delay the progression of renal disease.

The correct dyslipidemia: comprehensive therapeutic measures should be taken to achieve a good target for 2002 Asia Pacific lipid control, total cholesterol is less than 4.5mmol/L, high density lipoprotein cholesterol, triglyceride, 1.1mmol/L < 1.5mmol/L, low density lipoprotein cholesterol is less than 2.5mmol/L.

 

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