Diabetes is a common epidemic, and there are more than 100 million people with diabetes in China. There are endless patients to see every day, and the biggest wish of diabetics is “no medication”, and the most important concern is “will taking medication damage my kidneys”. Diabetes is a chronic glucolipid metabolic disease, long-term hyperglycemia and insulin resistance will cause macrovascular and microvascular damage throughout the body, eventually leading to serious complications of the kidneys, retina, cardiovascular and cerebrovascular over 10 years and 20 years. Today, we will talk to sugar lovers about diabetic nephropathy. Currently, no class of hypoglycemic drugs including injectable insulin provided by hospitals has nephrotoxic effects. Diabetes is caused by poor blood sugar control and high blood pressure for a long time before causing kidney damage and eventually renal insufficiency, making some hypoglycemic drugs can not be used properly. So only active glucose lowering and good glycemic control is the right way to avoid diabetic nephropathy. Epidemiological survey, the United States of 1462 cases of type 2 diabetes combined with chronic kidney disease greater than 20 years of age up to 40%; Shanghai 1009 cases of type 2 diabetes over 30 years of age combined with chronic kidney disease up to 64%. And once diabetes is combined with chronic kidney disease, its cardiovascular mortality rate is more than 1 times higher. Such a high incidence of sugar lovers how to avoid it? First of all, look at the diagnostic conditions of diabetic nephropathy. The direct indicator reflecting kidney function is creatinine clearance rate (GFR), which is the rate at which the waste products produced by metabolism in the body are excreted through urine, and if the excretory capacity is poor, it is impaired kidney function, see the table below. It can be calculated clinically by biochemical measurement of blood creatinine, which is called eGFR after correcting for age and other effects by the formula. stage 1 and stage 2 diabetic nephropathy have blood creatinine levels that are still in the normal range, and urine albumin measurement needs to be observed to detect early stage nephropathy. When the 24-hour urine microalbumin reaches 30mg is abnormal, it is considered as microproteinuria stage or early diabetic nephropathy stage; if it exceeds 300mg it is massive albuminuria or clinical proteinuria stage called diabetic nephropathy stage. Most diabetic nephropathy and its degree can be diagnosed simply by checking the microalbumin of urine and creatinine measurement of serum. The main diagnostic indicators of diabetic nephropathy are: any of the following manifestations lasting more than 3 months: albuminuria AER ≥ 30 mg/24h; ACR ≥ 30 mg/g or GFR < 60 ml/min/1.73m2 (GFR stage 3a to 5). The kidney damage caused by diabetic microangiopathy often takes time to develop, and studies have shown that diabetic nephropathy is less likely to occur in patients with type 1 diabetes within 5 years of onset, so urine protein should be routinely checked in patients with type 1 diabetes after 5 years of onset. If urine protein is positive, a quantitative urine protein test should be performed, and the cause of nephropathy should be analyzed to exclude urine protein caused by other diseases. If random urine protein is negative, urine microalbumin should be screened. If urine microalbumin is positive, it should be checked again more than twice in 3-6 months, and if two out of three times are positive, the patient is considered to have early diabetic nephropathy. If the urine is negative for microalbumin, it must be rechecked at least once a year. Microalbuminuria is a good predictor of the development of overt diabetic nephropathy in the future. Without specific intervention, approximately 80% of patients with microalbuminuria will progress to clinical diabetic nephropathy. Both international and national guidelines recommend dynamic monitoring of renal function in diabetic patients: serum creatinine (sCr) levels are tested at least once a year for chronic kidney disease (CKD) staging, regardless of whether the patient's urine albumin is normal or not. Urinary albumin/creatinine ratio: not less than 1 time per year. If type 1 diabetes mellitus with microalbuminuria is not effectively treated, the amount of albumin excreted will increase by 10% to 20% each year, and 80% of patients will enter clinical proteinuria after 10 to 15 years, and 50% of patients will develop end-stage renal disease (uremia) after 10 years. type 2 diabetes mellitus, when diagnosed, often has a longer disease duration, and the incidence of microalbuminuria and massive proteinuria is higher, if not treated effectively. If not effectively treated, about 20% to 40% of those with microalbuminuria progress to massive proteinuria, and 20% of patients develop end-stage renal disease. In the DCCT study, aggressive glycemic control reduced microalbuminuria by 34-54% in patients with type 1 diabetes ↓ massive proteinuria by 23-44%, and in the UKPDS study, aggressive glycemic control reduced the incidence of nephropathy and retinopathy in type 2 diabetes by 37%. intervention reduced the risk of progression to end-stage renal disease by 80%. The goal of diabetes treatment is to control various complications and delay the progression of renal, cardiovascular and cerebrovascular complications. The core treatment to prevent diabetic nephropathy remains how to control blood glucose well and not to develop early nephropathy with microalbuminuria. Those who have already had early nephropathy lesions need to actively control high blood sugar, control high blood pressure, regulate blood lipids and other comprehensive management to slow down the development of diabetic nephropathy to end-stage nephropathy and stay away from the pain of kidney dialysis.