Diabetic nephropathy is the most important microvascular complication of diabetes and the leading cause of end-stage renal disease. Studies have shown that the prevalence of diabetic nephropathy in patients with type 2 diabetes is about 30% to 50%, and if they enter the stage of massive proteinuria, they will progress to end-stage renal disease, which is commonly known as uremia, and the disease will worsen 14 times faster than other kidney lesions. Therefore, if diabetic nephropathy cannot be detected at an early stage and measures are taken to save kidney function, it will quickly evolve to the point where dialysis is required until the kidney is replaced. So, how to detect diabetic nephropathy in time? What are the priority measures that need to be taken? We're here to provide you with key information.
Diabetic nephropathy, abbreviated as DKD in English, is a chronic kidney disease caused by diabetes mellitus, and the diagnostic criteria mainly include a glomerular filtration rate of less than 60 ml/min/1.73 m2, or a urine albumin-to-creatinine ratio ACR higher than 30 mg/g for more than 3 months. There are 2 main manifestations of diabetic nephropathy, the first is urine albumin, of which the early manifestation is microalbuminuria. The second is diabetic retinopathy, which occurs before DKD in most patients with DKD.
For patients with type 2 diabetes, because the symptoms of microalbuminuria are not obvious, it is easy to be ignored, so if a signal of retinopathy is found, it should be paid enough attention to prompt examination. It should be noted that there are many factors affecting urinary albumin, usually need to be re-examined within 3 to 6 months, and at least 2 of the 3 test results exceed the critical value, and diabetic nephropathy should be considered. In addition, infection, fever, heart failure, ketoacidosis, etc., will affect the detection results of urine albumin, therefore, early diagnosis of diabetic nephropathy, can not rely on the test results of urinary albumin, should also refer to other test results and symptoms and manifestations, such as glomerular filtration rate and visual changes.
Diabetic nephropathy, typical glomerular pathological changes, including thickening of the glomerular basement membrane, widening of the mesangial stromal, and glomerular sclerosis, can be classified as 4 grades of glomerular damage. In addition, the degree of renal function impairment can also be graded according to the change of glomerular filtration rate GFR, which is more than 90, which belongs to stage 1, indicating that kidney damage has occurred. When the GFR value is below 15, it belongs to stage 5, indicating renal failure and the need for dialysis.
The prevention and treatment of diabetic nephropathy can be divided into 3 stages. Stage 1, which is the timely detection of diabetes, should be taken seriously in the prediabetes phase of prediabetes with impaired glucose tolerance or fasting blood glucose, and to strengthen screening, especially in people with a family history or obesity. Because the prevalence of diabetes is very high, and, with diabetes, the risk of diabetic nephropathy will rise sharply, therefore, ordinary people should establish a sense of prevention, do not think that diabetes is a disease that many people have, let down their vigilance, but should soberly realize that this is a battle to save kidney function. After all, DKD develops to a later stage, can only rely on dialysis to prolong life, and very few people can conditionally change their kidneys.
The second stage in the prevention and treatment of diabetic nephropathy is early treatment, which reduces or delays the occurrence of large amounts of proteinuria. After the diagnosis of type 2 diabetes, at least once a year screening of urine albumin, creatinine, glomerular filtration rate, timely detection of DKD, once the corresponding indicators change, it is necessary to pay attention to standardized treatment. The third stage is to prevent or delay the occurrence and progression of renal insufficiency, which requires the control of blood glucose and blood pressure levels, correction of lipid metabolism disorders, reduction of urinary protein, and treatment of complications.
The prevention and treatment of diabetic nephropathy requires lifestyle changes. There are five main points for specific measures. The first is exercise, regular and moderate exercise, which helps to reduce weight, control blood sugar and blood pressure levels, improve lipid metabolism, improve quality of life, and at the same time, improve cardiopulmonary function, reduce inflammation, and delay kidney function damage. Exercise should include aerobic exercise, resistance exercise, and flexibility training. The second is weight loss. The third is to quit smoking. The fourth is to limit protein intake, supplementing protein mainly poultry, fish, soybeans, and plant protein. The fifth is to limit sodium intake, and the average daily salt intake should be controlled within 5 grams.
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