Diagnosis of diabetic nephropathy The diagnosis of diabetic nephropathy can be considered in patients with a history of diabetes mellitus of 5-10 years or more, with varying degrees of proteinuria and the presence of diabetic retinopathy or other complications. According to the course of diabetic nephropathy and pathophysiological evolution, it can be divided into 5 stages. Stage I-II: No obvious clinical manifestations. Stage III: persistent microalbuminuria stage: urinary microalbumin excretion rate (UAER) 20-200ug/min and blood pressure starts to rise. Stage IV: clinical diabetic nephropathy stage, with massive proteinuria (UAER>200ug/min), markedly elevated blood pressure, and decreased renal function. Stage V: End-stage renal failure stage, requiring dialysis treatment. Prevention and treatment of diabetic nephropathy The prevention and treatment of diabetic nephropathy focuses on active control of blood glucose up to the standard and regular screening for diabetic nephropathy. For patients with diabetic nephropathy with microalbuminuria or massive proteinuria, the application of angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists can slow down the progression of diabetic nephropathy. For patients with end-stage diabetic nephropathy (stage V), or patients with intractable volume overload, hypertension, or malnutrition due to low protein diet, dialysis treatment should be started promptly. 1, diet therapy: low salt, low fat diet is the dietary principles of diabetic nephropathy, patients with renal insufficiency should also limit the intake of protein in the diet. Excessive protein intake can increase glomerular hyperfiltration and promote glomerular basement membrane thickening. The protein intake should be mainly high biomass protein, such as lean meat, beef, fish, eggs, etc. Limit salt intake, and vegetable oil is preferred for cooking. If the kidney function is obviously abnormal, also limit some food containing high potassium. 2, physical exercise: appropriate exercise according to the condition. Early diabetic nephropathy can be aerobic exercise based on fast walking. Avoid prolonged and intense exercise that can continuously raise blood pressure. If albuminuria occurs, it is not advisable to carry out more intense exercise therapy. 3, control blood sugar: according to the patient’s condition, under the guidance of a physician to choose oral hypoglycemic drugs or also apply insulin. Those with renal hypofunction should not use biguanide hypoglycemic drugs to avoid lactic acidosis. For oral hypoglycemic drugs can not well control blood sugar and renal function damage is obvious, should be treated with insulin early. But for end-stage renal disease patients should pay attention to the lack of food and insulin inactivation, it is easy to occur hypoglycemia, and because the renal sugar threshold is elevated, even if the blood glucose is elevated, but urine sugar is often negative, so at this time should often monitor blood glucose, in order to adjust the insulin dose. 4, blood pressure control: antihypertensive treatment should start with restricting salt intake, reducing body weight, and quitting smoking and alcohol. The target value of blood pressure control is less than 130/80 mmHg, and if urine protein is ≥1 g/day, blood pressure should be controlled at or even below 125/75 mmHg to slow down the decline of renal function. The use of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor antagonists (ARB) can not only reduce systemic hypertension, but also reduce urinary protein and slow down the progression of renal lesions. 5. Correction of dyslipidemia: Comprehensive therapeutic measures should be taken to achieve the goal of good lipid control in the Asia-Pacific region in 2002, i.e. total cholesterol <4.5mmol/L, HDL cholesterol >1.1mmol/L, triglycerides <1.5mmol/L and LDL cholesterol <2.5mmol/L.