A Increasing number of diabetic nephropathy year after year Zhang Chuan, Department of Endocrinology, Second Hospital of Jilin University
Diabetes is not such a terrible disease as long as the daily blood sugar is properly controlled. However, because diabetes is neither feverish nor painful in various parts of the body, many people ignore the examination of the disease while its condition is progressing forward. If it is allowed to progress downward, or if inappropriate treatment is used, after about 5 years and 10 years, serious complications can arise.
Complications usually caused by diabetes include neurological disorders, retinopathy, and, in this case, nephropathy, which are collectively referred to as the three major comorbidities of diabetes. Among them, retinopathy can lead to blindness if it progresses further, while end-stage renal disease, because of renal insufficiency, cannot sustain life without dialysis.
The kidneys have the important function of filtering the waste products transported by the blood and excreting them out of the body in the form of urine. As kidney disease progresses the function of converting into urine becomes low and eventually the function of the kidney must be replaced by an artificial kidney, which is called dialysis therapy.
Unfortunately, the number of people undergoing dialysis for diabetes in our country has been increasing recently. There are now 270,000 people on dialysis nationwide, 30% of whom are diabetic kidney patients. And of the 36,000 patients who started dialysis only recently, 16,000 (in 2007) were diabetic kidney patients, which is more than 40%, and is the number one reason for having dialysis.
Moreover, the results of patients who received dialysis for diabetes are not very positive when compared with those who had dialysis for other diseases after dialysis.
B cause is high blood sugar
Why does diabetes cause kidney disease?
The kidneys are made up of a collection of tiny blood vessels called tethered globules. These thylakoid bodies are about 1 million in each of the left and right kidneys, and each thylakoid body serves to filter the waste products in the blood.
Diabetic nephropathy is caused by high blood sugar because the small blood vessels in the thylakoid become narrow and cannot adequately filter waste products.
We call the disease that arises in the small blood vessels collectively as small vessel disease. The three major complications of diabetes are all caused by microvascular disease. In the retina, as in the kidney, there are many small blood vessels, and high blood sugar causes changes in the normal structure of these small vessels over a long period of time, which eventually leads to disease.
We know that kidney patients with high blood pressure, obesity, high protein, high salt, coupled with the pressure of social life and other adverse factors, the disease will accelerate the development.
Process of diabetic nephropathy development.
The tethered spheres of the kidney do not filter proteins, red blood cells, white blood cells, etc. under normal conditions, but only water, electrolytes, and waste products, which form the main components of urine. However, if blood sugar remains high, the blood vessels of these tethered spheres become hardened and narrowed, and at the same time, the filtering function is reduced, gradually forming proteinuria, and eventually urination becomes difficult and the body’s waste products cannot be excreted, becoming uremic syndrome.
C Early detection is vital. Microalbuminuria should be checked regularly
Diabetic nephropathy, because there are no symptoms, develops little by little without realizing it. When the urine protein test is positive and the body is swollen, the nephropathy has developed to a considerable extent and the treatment is centered on the treatment of nephropathy. Therefore, it is very necessary to detect kidney disease as early as possible.
Doing the test of micro leukodystrophy urine is effective for the detection of early kidney disease. This test uses a highly sensitive method to detect trace amounts of protein from urine. Although this is a new test, it is no different from a normal urine test for the person undergoing the test.
Generally speaking, diabetic patients with poorly controlled blood sugar will develop kidney disease complications after about 10 years. Type 2 diabetes, on the other hand, does not know when it starts to develop. Therefore, as long as the diabetic patients, including those with good blood sugar control, from the point of view of prevention, at least once a year to carry out the examination of white prion urine. Also, people who have positive test results should confirm whether their kidney function is low, including blood tests, and have a test for white prion urine several times a year.
D When kidney disease is detected
There are 5 main stages of kidney disease from the stage of positive microscopic leukoprionuria test to the stage of dialysis, and the condition and treatment method are different at each stage.
Progression of kidney, disease, and treatment
Disease stage
Normal stage
Microalbuminuria stage (early nephropathy)
Overt nephropathy stage
Renal insufficiency stage
Dialysis phase
Characteristics of the disease
No clinical symptoms
Microalbuminuria test is positive
No sensation, many people’s blood pressure is rising during this period
Positive proteinuria
Rapid deterioration of kidney function and introduction of dialysis into the picture
Some patients will have swelling during this period
The kidneys of the tethered spheres are unable to filter the blood, urinary toxins are retained in the blood, and the working condition of the cells deteriorates.
Uremia
Anemia
Lethargy of the body
Uremic nerve pain
Nocturnal pain in the hands and feet
Itchy skin
Sclerosing nephrosis syndrome
Chronic body swelling
Urine protein of 3.5g or more
(sometimes up to 10-15g)
Note: At first glance it looks as if diabetes is cured
In the case of insulin-dependent drug therapy, because of low kidney function, the breakdown is delayed and the duration of action in the body becomes longer
Characteristics of treatment
The purpose of treatment – prevention
1 Efforts to control blood sugar
2 Avoid excessive consumption of salt and protein
Salt is controlled to less than 10g per day
(Japanese about 13g per day)
Protein 1g per kg body weight per day
3Efforts to lower blood pressure
Get into the habit of measuring blood pressure with a sphygmomanometer
Objective of treatment – to suppress the course of the disease
1 Strict control of blood sugar
2Management of blood pressure
Take antihypertensive drugs if necessary
3 Reconfirm the intake of test
(7g per day)
Purpose of treatment – delaying the progression of the disease
1Strict control of blood sugar
2 Management of blood pressure
3 Switching of food therapy (this is the focus of treatment of kidney disease)
Limit the intake of salt and protein
Salt less than 5g per day
Protein less than 1g per kg body weight per day
(0.8g is the target if possible)
4 Suppress swelling
If necessary, take diuretics
Aim of treatment – control the disease
1 The treatment of kidney disease should focus on food therapy
Salt and protein intake should be limited
3g of salt per day
0.6g of protein per day for 1kg of body weight
2 Continue blood pressure control
3 Watch for the occurrence of hypoglycemia
4From SU medicine to yds
5Restrict water
E Hemodialysis and peritoneal dialysis
There are two main specific methods of dialysis. One is hemodialysis and the other is called peritoneal dialysis as CAPD. Hemodialysis accounts for 90% of the dialysis performed in Japanese hospitals. The time and method of starting dialysis is determined by the attending physician depending on the condition.
Hemodialysis is performed three times a day, takes 4-5 hours, and is performed in a hospital. Unlike hemodialysis, which must be performed in a hospital, there are no restrictions on time or place because peritoneal dialysis can be carried. However, since a catheter must be inserted into the peritoneum of the mesh, it is easy to cause peritonitis if care is not taken in terms of hygiene.
When dialysis is started, food therapy is changed according to the method of dialysis. Up to this stage, the requirement to restrict protein intake is somewhat eased. Also, on non-dialysis days, water intake must be controlled because water tends to accumulate in the body.
In end-stage renal insufficiency, in addition to dialysis therapy, kidney transplantation is also available. Kidney transplantation has a high success rate and is more effective than dialysis in terms of return to society and life. Kidney transplantation for diabetic nephropathy is not practiced much in Japan now.
Even if you receive kidney dialysis while returning to society is very possible, there is also a network connection between hospitals, not to mention domestic travel, and recently, there is an increase in the number of people who travel overseas happily while undergoing dialysis.
F Key points to prevent diabetic nephropathy
The biggest cause of diabetic nephropathy is high blood sugar. In the prevention aspect of kidney disease, it is important to control blood sugar well.
On one hand, even if the kidneys are not diseased, like other organs such as the lungs and heart, the function of the kidneys ages with age, and this, together with an overeating, high-protein diet, etc., drives the function of the kidneys even lower. Regardless of how it is said, as long as adequate attention is paid to the diet, you can prevent kidney disease, in daily life should be careful not to be too fat, too much salt, meat and other protein intake is also not too much.
There is also with the increase in age, the function of the kidney is getting lower and lower, has passed 50 years old gender difference is very obvious. Compared with a little change in women, the change in men is more obvious. In other words: men have a tendency to get kidney disorders. Likewise, if there is someone in the family who has kidney disease, there is also a tendency to get kidney disease due to genetic factors, as well as similar environmental and food habits. This must be noted.
G kidney patients should lead a relaxed life
Complications of diabetes develop in the process of unawareness. One of the symptoms of kidney disease patients is body swelling, and when you pay attention to this, kidney disease has already developed to the stage of dialysis introduction.
In addition, if the complication of kidney disease, plus for diabetes to be food control, but also control the salt and protein that endanger the health of the kidneys, all these are based on the kidney disease, so the food therapy becomes more difficult.
Even if you don’t feel anything, blood sugar control should be managed well, urine tests should be performed regularly, and you should be careful not to take too much salt and protein in your diet, and you should practice a relaxed and happy life for your kidneys, which is very important in preventing diabetic nephropathy.