Understanding kidney disease, early detection and treatment I. What is thirst disorder (diabetes)? Diabetes mellitus is the name of a disease in traditional Chinese medicine and is basically the same as diabetes mellitus in modern medicine. It is a comprehensive disease characterized by excessive drinking, polyuria, polyphagia, lethargy, fatigue and sweet urine. If laboratory tests are done, the main characteristics are high blood sugar and urine sugar. If the disease is prolonged, the internal organs are damaged and boils, carbuncles, dizziness, chest paralysis, deafness, blindness, numbness and pain in the limbs, gangrene in the lower limbs, edema in kidney failure, and coma in stroke. (A) Diagnostic criteria 2010 ADA diagnostic criteria for diabetes: 1. Glycosylated hemoglobin ≥ 6.5%. 2, fasting blood glucose ≥ 7.0 mmol/l (fasting is defined as no caloric intake for at least 8 hours). 3, 2-hour blood glucose ≥ 11.1 mmol/l at oral glucose tolerance test. 4, Random blood glucose ≥ 11.1 mmol/l in patients with typical symptoms of hyperglycemia or hyperglycemic crisis. In the absence of clear hyperglycemia, the criteria should be confirmed by repeated testing 1 to 3 times. (2) Treatment principles Long-term adherence to standardized treatment is the most important, including: control of diet, adherence to appropriate exercise and reasonable use of drugs. 1.When you find the symptoms of “three more and one less”, you should go to the hospital in time to get a clear diagnosis. If it is determined that the disease is thirsty and requires inpatient treatment, hospitalization is required to avoid delaying the condition. The symptoms are often not obvious in the elderly, so you should check urine sugar and blood sugar regularly (once every six months or once a year). 2.Reasonable diet allocation. Less into sweet food, root vegetables such as: potatoes, white potatoes, yams. To properly limit fruit. Should promote coarse fiber food such as: brown rice, beans, green leafy vegetables, cabbage, mung bean sprouts, cucumber, celery, tomatoes, etc. Consume more refined protein such as: lean meat, eggs, milk, and fish. Choose vegetable oil, less into animal offal food, etc. 3, adhere to appropriate activities. Appropriate and regular activities are an important means of treating thirst, such as walking, aerobics, tai chi, table tennis, swimming and running. You can choose the activity according to your physical condition. Be persistent. Each patient should have his or her own diary of blood glucose self-monitoring, and develop the good habit of recording it every day. 2. The relationship between blood glucose and meals, i.e. before or after meals. 3. The result of blood glucose or urine glucose. 4.The time and type and dose of insulin injection or taking oral hypoglycemic drugs. 5.Any factors affecting blood sugar, such as the type and amount of food eaten, exercise, illness, etc. 6. The time when the symptoms of hypoglycemia appear, the relationship with medication, eating or exercise, etc. You should bring your blood sugar monitoring diary to every hospital visit to discuss with your doctor how to adjust your treatment. Second, what is achalasia nephropathy (diabetic nephropathy)? The incidence of achalasia has been increasing year by year in recent years, and the age of onset tends to be younger. Achalasia nephropathy is a common and frequent clinical complication of achalasia, with an incidence rate of about 34.7%, second only to cardiovascular disease, and is one of the most serious complications of achalasia. Thirsty nephropathy has become one of the main causes of uremia. Thirsty nephropathy (diabetic nephropathy) is a major microvascular complication of thirsty disease, mainly referring to thirsty glomerulosclerosis, a glomerular lesion with predominant vascular damage. In the early stage of achalasia, the kidney volume increases, the glomerular filtration rate increases and is hyperfiltered. Later, interstitial proteinuria or microalbuminuria gradually appears, and with the prolongation of the disease, persistent proteinuria, edema, hypertension, reduced glomerular filtration rate, and then renal insufficiency and uremia, which is one of the main causes of death in achalasia. Diabetic nephropathy can be divided into 5 stages: Glomerular hyperfiltration stage (stage I) This stage mainly shows that the patient’s glomerular filtration rate is increased and the urinalysis is completely normal. If the patient’s hyperglycemia is corrected in time, the kidney damage can be completely recovered in this stage. Intermittent microalbuminuria may occur during this period, i.e., the urinary albumin excretion rate is normal when the patient is at rest, but increases abnormally during stress (e.g., exercise, fever, etc.). If blood glucose and blood pressure are strictly controlled during this period, the lesions can still be delayed. In the early stage of nephropathy (stage III), the presence of persistent microalbuminuria is a sign of entering this stage, and the rate of urinary albumin excretion increases when the patient is at rest, but the urine tests are still negative for protein. It is important to emphasize that the renal lesions are irreversible from this stage onwards. It occurs in patients with thirst for >5 years and may be shortened if glycemic control is poor. The nephrotic stage of clinical achalasia (stage IV) begins with a positive urine test, followed by a rapid increase in urine protein and within a few years a large amount of proteinuria (urine protein quantification over 3.5 g/day) and nephrotic syndrome, with generalized swelling, large amounts of ascites and pleural fluid, and considerable difficulty in diuresis. In the stage of renal failure (V), starting from the appearance of proteinuria, the patient’s renal function deteriorates rapidly, often progressing to renal failure and renal anemia within three to four years. Patients with thirsty nephropathy have entered the renal failure stage, but the amount of urine protein does not decrease, still presenting a nephrotic syndrome, it is difficult for patients to maintain good nutrition, and it is easy to develop a variety of complications. Patients at this stage must rely on renal replacement therapy (dialysis or kidney transplantation) to survive. Screening indicators for early achalasia nephropathy (diabetic nephropathy): urine albumin/creatinine Type 2 achalasia occurs mostly in middle-aged and elderly people, and patients are often combined with hypertension, hyperlipidemia and hyperuricemia, which together with hyperglycemia damage the kidneys. The earliest manifestation of kidney damage is the presence of microalbumin in the urine. Therefore, after excluding other factors causing kidney disease. The degree of kidney damage can be determined by measuring urine albumin/creatinine. Therefore, it is important for patients with achalasia (especially those who have had the disease for several years) to have regular checkups to assess the degree of kidney damage so that early (stage I-III) kidney damage in achalasia can be detected and treated actively. It is important to know that proper treatment at this early stage is the key to remission or delayed development of renal damage in achalasia. Waiting until the urine test is positive for protein is too late for treatment. The diagnostic criteria for diabetic nephropathy are based mainly on the increase in urinary microalbumin excretion rate (i.e. urinary microalbumin/creatinine) (normal <20μg/min, <30mg/24h). The diagnosis requires 2 consecutive urine tests within 6 months with a microalbumin excretion rate >20 μg/min but between 30 and 300 mg/24h, and other possible causes of its increase should be excluded, such as urinary tract infection, exercise, primary hypertension, heart failure and increased water load. If the urinary albumin excretion is still 20-200 μg/min when diabetes is effectively controlled, it can be considered to have early diabetic nephropathy.