I have diabetic nephropathy, what should I do? How far is it from kidney failure? Share it with friends who need to know

With the improvement of living standards, material life is extremely rich and often sedentary, more and more People suffering from wealth disease—diabetes, about 20-40% of diabetic patients will develop diabetic nephropathy. Nowadays, people with diabetes are getting younger and younger, and some young people in their 20s and 30s are prematurely exposed to the threat of diabetes. As a result, the age of onset of diabetic nephropathy is also advancing and increasing. Physical, mental and financial burden. What is diabetic nephropathy? is it serious? Can it be cured? Kidney failure? Today, an expert in diabetic nephropathy, Dr. Zhou Yue, will tell us in detail.

1.

What is diabetic nephropathy

diabetic nephropathy refers to chronic kidney disease caused bydiabetes, usually in patients withproteinuriaordecreased glomerular filtration rate, 2 1 or both. It is not diabetes + proteinuria or renal function damage, it must be diabetic nephropathy, it may also be diabetes combined with other types of kidney disease, such as diabetes combined with IgA nephropathy, diabetes combined with membranous nephropathy, etc. Typical clinical manifestations of diabetic nephropathy are: firstmany years of history of diabetes, followed by proteinuria and renal failure Decreased function, and often with diabetic retinopathy. Proteinuria begins with microalbuminuria→gradually develops into marked proteinuria without hematuria, and renal function begins with increased glomerular filtration rate→decreased. (We will explain in detail what this means later)For the pathogenesis of typical diabetic nephropathy, doctors can usually diagnose and treat directly based on experience. However, when the patient does not meet the characteristics of typical diabetic nephropathy and considers the possibility of other nephropathy, doctors are more inclined to perform renal puncture firstrenal puncture span>, renal puncture confirms the diagnosis before treatment. Any of the following features is highly suspected not to be diabetic nephropathy

  • Fundus examination revealed no diabetic retina Lesion

  • red blood cells in urine sediment Casts, malformed erythrocyte or leukocyte casts

  • An illogically rapid increase in albuminuria, or a sudden and rapid decrease in GFR, such as a sustained increase of more than 5-10 times in proteinuria in less than 1-2 years, and an annual decrease in GFR Greater than 5ml/min/1.73m2

  • If there is a physical examination report and it is found that there is an increase in urine protein before diabetes

  • There is another systemic disease related to kidney disease, For example, systemic lupus erythematosus

  • type 1 diabetes mellitus has significantly elevated urinary protein within 5 years of onset (>300mg/day)

2.

Is diabetic nephropathy serious?

diabetic nephropathy is also mild or severe, and the severity of the disease can be assessed from three dimensions: urine protein, renal function and pathology. If a patient has more protein in the urine, poorer renal function, and more severe pathology, the more severe the disease is. The heavier, the greater the risk of uremia. Let me talk about pathology first: typical diabetic nephropathy, pathological manifestations include basement membrane thickening, mesangial hyperplasia, tuberous sclerosis and Glomerulosclerosis. Pathological grades I and IIa are relatively mild, grade IV is severe, and grades IIb and III are intermediate.

from renal function: /span>CKD stage 1-2 is early, and renal function is OK; stage 3b-4 is late, and renal function is very poor; stage 3a is in the middle. Stage 5 is the most serious,Uremia period. (If you don’t know your CKD stage, you can click the image below to calculate)

Explain a little, early diabetic nephropathy here Abnormally elevated glomerular filtration rate may occur. Many people may be a little confused. Isn’t the glomerular filtration rate the higher the better? This is because the diabetic milieu activates the RAAS system and many other downstream mediators, triggering renal hypertrophy and increased glomerular blood flow, which together lead to glomerular filtration rate Abnormal increase, such as the following test results of a patient with early diabetic nephropathy, the glomerular filtration rate is too high, so it is not necessarily that the lower the serum creatinine, the better, the higher the glomerular filtration rate. The higher the better, the individual analysis of the individual situation.

Tests for patients with early diabetic nephropathy▽

3.

Can diabetic nephropathy be cured?

Let’s first take a look at the natural development process of diabetic nephropathy. Natural development means letting it develop without intervention. Due to poor control of persistently elevated blood sugar, patients with diabetes may develop microalbuminuria after 5-10 years of development; after another 10 years, they gradually develop into marked proteinuria. After about 20-30 years of development, it can develop into renal failure or major cardiovascular disease and death.

Then we can predict that a 30-year-old 100% of young people develop diabetes, and if they are not properly managed, they are at greater risk of developing major diseases such as cardiovascular disease or kidney failure when they are in their 50s and 60s.

However, what we just talked about is the natural course of the disease. With the advancement of modern medical technology, as long as patients recognize the seriousness of the disease, early prevention and control , with the regular follow-up review by a good doctor, and taking medicine on time, it is entirely possible to achieve a stable condition and not develop in a bad direction.

Through strict control of blood sugar, blood pressure, and blood lipids, a considerable number of patients with a small amount of albuminuria may completely subside and reverse the cure. Or keep it steady. In some patients with significantly increased proteinuria, it is also hoped that the treatment will reduce to the safe range of a small amount of proteinuria, or completely normal.

4.

How to avoid kidney failure

For diabetic patients, prevention Renal failure and prevention of cardiovascular disease are placed on equal footing. Many diabetic patients do not pay attention to disease management. Later, it is not that they do not develop renal failure, but they have no “opportunity” to develop renal failure. Before renal failure, because of Cardiovascular disease causes premature disability or death. Therefore, for diabetic kidney patients, not only the kidneys, but also the heart, how exactly? Looking carefully at the picture below, we want to start from Life, Indicators, Drugs Manage diabetic kidney disease in many ways:

< life

Quitting smoking: Smoking increases the risk of coronary heart disease by 54%, stroke by 44%, myocardial infarction by 52%, and can damage kidneys The structure and function of the small ball, we must resolutely quit smoking.

Low-salt diet, proper control of protein intake, generally recommended protein intake for diabetic kidney patients is 0.8g/kg/day; span>Exercise: 3-5 times a week, half an hour each time, at least 150 minutes of exercise, such as brisk walking, jogging, etc.

Metrics

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GlucoseA hyperglycemic environment is central to kidney and heart damage Therefore, it is very important to meet the blood sugar target. As for how much blood sugar is up to standard, different patients have individualized guidance. We have strict requirements for some patients; some can be relaxed. The following picture shows the approximate range of strict, general, and relaxed blood sugar control:

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Usually we recommend that most patients: HbA1c <7%, To achieve this goal, preprandial blood glucose Generally controlled between 4.4-7.2mmol/l; postprandial blood sugar <10. For very young patients with long life expectancy, early stage renal disease, few complications, and strong health awareness: recommended HbA1c within 6.5% , to achieve this goal, fasting and postprandial requirements will be stricter. For the elderly and frail patients with short life expectancy and many comorbidities: recommended glycated hemoglobin within 8% To achieve this goal, fasting and postprandial requirements are more relaxed. blood pressureusually recommended< span>130/80mmHg. For some young patients with high proteinuria, blood pressure may be lower, such as within 125/80mmHg. Lipids:No cardiovascular disease yet , it is recommended to control low-density lipoprotein cholesterol (LDL-C) below 2.6mmol/lFor patients with cardiovascular disease, it is recommended that low-density lipoprotein cholesterol be controlled Tighter control (LDL-C): below 1.8mmol/l

proteinuria

if possible, Strive for normal, or within ACR300mg/g, or within 24 hours urine protein quantitative 500mg/day

Medication Management

due to< strong>RAS blockers and SGLT2ihave been shown to significantly delay the progression of diabetic nephropathy, as well as prevent and improve cardiovascular disease, if the patient has no contraindications (such as high potassium, dehydration, etc.), Most patients with diabetic nephropathy are recommended to use these two drugs to control urinary protein and delay the decline of renal function.

(to learn more about these two drugs, click → SGLT2i, the arrival of the new drug era for diabetic nephropathy, hypoglycemic Reduce protein, protect the heart and protect the kidney!; RAS blocker, a “life-saving drug” to avoid uremia, we owe it a “thank you”!)

In terms of blood sugar, the first-line drug ismetformin, and other hypoglycemic drugs can be combined if necessary.

5.

Strategically defied

Tactical attention

Due to the fact that there is usually no discomfort in the early stage of diabetic nephropathy, it is not easy to be taken seriously. Diabetes patients must pay attention to the annual regular urine examination and renal function, and detect the clues of kidney disease as soon as possible. The speed will be significantly faster. Frozen three feet, not a day’s cold. When there are no symptoms, let everyone manage the indicators well. Many people have insufficient awareness and lack of motivation, but once it becomes serious, they will regret it too much.society is a huge burden. For patients who have been found to have diabetes, don’t be discouraged, cooperate with doctors to improve their lifestyles and use drugs rationally, and strive to control urine protein, blood pressure, blood lipids and other indicators to a safe level as soon as possible. range, keep kidney function stable and prevent cardiovascular disease! Come onReferences:

Diabetic kidney disease: Manifestations, evaluation, and diagnosis.UTD

Treatment of diabetic kidney disease.UTD

Diabetic kidney disease: Manifestations, evaluation, and diagnosis. UTD

Chinese Guidelines for the Prevention and Treatment of Type 2 Diabetes (2020 Edition). Chinese Journal of Diabetes

KDIGO 2020 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease