Diabetic nephropathy is a common complication of diabetes mellitus, one of the manifestations of diabetic systemic microangiopathy, clinically characterized by proteinuria, progressive renal impairment, hypertension, edema, and severe renal failure in advanced stages, and is one of the major causes of death in diabetic patients. In recent years, with the increase of life expectancy of our population and the change of living and eating habits and structure, the prevalence of diabetes has been on the rise. According to the latest statistics, about 50 million people in China are currently facing the threat of diabetes. For this reason, it is crucial to prevent its serious complications. In the United States, diabetic nephropathy accounts for the first place of end-stage renal failure, which is about 35-38%. In Chinese medical literature, diabetic nephropathy is not only a disease of thirst, but also a disease of edema, urinary turbidity, bloating, and guangs within the scope of kidney disease. The disease mechanism is mainly based on kidney deficiency, with the initial leakage of essence, prolonged unfavorable gasification, internal stagnation of water and dampness, and even internal accumulation of turbidity and toxicity, with the deficiency of organ qi, which is prone to change.
I. Staging of diabetic nephropathy
According to Mogensen’s classification, diabetic nephropathy can be divided into 5 stages, I-V stage.
Stage I: for the initial stage of diabetes, the kidney volume increases, the glomerular filtration rate increases, the small glomerular arteries into the glomerulus expand, and the glomerular internal pressure increases.
Stage II: Glomerular capillary basement membrane thickening, urinary albumin excretion rate (AER) mostly in the normal range or intermittently increased (e.g. after exercise).
Stage III: early nephropathy with microalbuminuria, i.e., AER persists at 20-200 μg/min (<10 μg/min in normal subjects).
Stage IV: clinical nephropathy with gradual increase of urinary protein, AER>200μg/min, i.e. urinary albumin excretion >300mg/24h, equivalent to total urinary protein >0.5g/24h, decreased glomerular filtration rate, may be accompanied by swelling and hypertension, and gradual decrease of renal function.
Stage V: Uremia, most of the renal units are atretic, AER is reduced, blood creatinine and urea nitrogen are elevated, and blood pressure is elevated.
(1) Diagnosis of early diabetic nephropathy.
It is mainly based on the increase of AER (normal <20μg/min, <30mg/24h). The diagnosis requires 2 consecutive urine tests within 6 months with microalbumin excretion rate >20μg/min but <200μg/min (i.e. between 30 and 300mg/24h), and other possible causes of its increase should be excluded, such as urinary tract infection, exercise, primary hypertension, heart failure and water
increased load, poor control of diabetes mellitus, etc.
(2) The diagnosis of clinical stage diabetic nephropathy is based on the following
① History of diabetes mellitus;
(2) Intermittent or persistent clinical proteinuria (positive urine protein), among other causes, is the key to the diagnosis of clinical DN;
③ May be accompanied by renal insufficiency;
④ Concomitant retinopathy;
⑤ Confirmation by renal biopsy.
Diabetic nephropathy treatment
1.Behavioral intervention therapy.
(1) Control the diet: control the protein intake, the daily protein intake is 0.8-1.0g/kg for those with normal renal function, and give low protein diet, i.e. 0.6g/kg for those with renal insufficiency.
(2) Enhance physical exercise.
2.Control of blood sugar: oral hypoglycemic drugs and application of insulin.
3.Control hypertension: ACEI antihypertensive drugs are preferred, which can help reduce proteinuria and delay the progression of diabetic nephropathy.
4.Control of hyperlipidemia: pharmacotherapy + food therapy is needed. For those with increased serum cholesterol, hydroxymethylglutaryl coenzyme A reductase drugs are preferred; for those with increased serum triglycerides, fibrate derivatives are preferred. Dietary treatment should be less cholesterol and saturated fatty acid-rich foods (mainly animal fats).
5, the emergence of chronic renal failure, uremic phase, the use of kidney replacement method of treatment (hemodialysis, peritoneal dialysis or kidney transplantation).
6.In recent years, a combination of Chinese and Western medicine has been used for treatment. By repairing the intrinsic cells of the diseased kidney, the kidney function is continuously improved to effectively control the progress of the disease.
Three, diabetic patients daily life precautions
1.Prevent hypoglycemia. Morning exercise should not be fasting; after dinner to bedtime, such as work, activity time is too long, to moderate additional meals; occasional occurrence of hypoglycemia, should immediately drink sugar water, juice or eat a small amount of candy. However, this approach should not be used for a long time, and the doctor should be requested to adjust the dose of drugs or insulin in time.
2.Rational diet. Regular diet to stabilize blood sugar. Eat more fiber-rich coarse grains, wheat bran, vegetables, etc. Bean products, melon seeds and peanuts are rich in vegetable protein and vegetable oil can be used in moderation. Food seasoning should be light. If you eat more starchy food, you should reduce the amount of staple food. Do not add extra pastries, candy, cookies, ice cream, lotus root powder and other foods; most fruits contain high sugar content, affecting blood sugar, should not eat more, not to eat every meal.
3, appropriate exercise. Light and moderate physical exercise is appropriate, generally brisk walking, jogging, cycling, up and down stairs, tai chi, housework, etc. is good.
4, careful with new food. For any new varieties of food, we must first find out the main nutrients. For diabetes health products or “low sugar food”, should be carefully selected.
In short, as the saying goes: “Spring cover and autumn freeze”, which is especially important for diabetic patients. Pay attention to the cold and keep warm, prevent colds; especially in early spring, winter cold has not yet disappeared, should pay more attention to the living, pay attention to the mood regulation, so that their spirit and mood with the spring nature, strengthen the body immunity, reduce complications, the condition can be improved.