Nephropathy – a disease in which kidney function is disturbed.
Diabetic nephropathy – a kidney, developing due to diabetes mellitus. Renal disease are in the renal tissue, which leads to loss of kidney health.
Diabetic nephropathy is one of the most frequent and dangerous complications of diabetes. Occurs with insulin (40%) and insulin dependent (20-25% of cases) types of diabetes.
Feature of diabetic nephropathy is a gradual and almost asymptomatic development. The first phase of the disease does not cause any discomfort, so often a doctor has already treated in the last stages of diabetic nephropathy, which is almost impossible to cure what has changed.
It is therefore an important task is the timely investigation and detection of early signs of diabetic nephropathy.
The reasons for the development of diabetic nephropathy:
The primary cause of diabetic nephropathy is decompensation of diabetes mellitus – Long-term hyperglycemia.
Consequence of hyperglycemia is high blood pressure, which also affects the kidneys.
With the high sugar and high blood pressure kidneys cannot function properly, and substances that must be removed by the kidneys, eventually accumulate in the body and cause its poisoning.
Increases the risk of diabetic nephropathy and hereditary factor – if the parents had been violations of the kidneys, the risk increases.
Stage of diabetic nephropathy:
Distinguish five main stages of diabetic nephropathy.
Stage 1 – develops in early diabetes.
Characterized by an increase in glomerular filtration rate of more than 140 ml / min, an increase in renal blood flow and normoalbuminuria.
Stage 2 – develops when the small experience of diabetes (no more than five years). At this stage, initial changes of renal tissue.
Characterized normoalbuminuria, increased glomerular filtration rate and thickening of basement membranes and mezangiuma glomeruli.
3rd stage – at the experience of developing diabetes from five to 15 years.
Characterized by periodic increases in blood pressure, elevated or normal glomerular filtration rate and microalbuminuria.
4-th stage – the stage of severe nephropathy.
Characterized by normal or reduced glomerular filtration rate, hypertension and proteinuria.
5-stage – uremia. Develops when the big experience of diabetes (more than 20 years).
Characterized by decreased glomerular filtration rate, and arterial hypertension. At this stage, the person experiences the symptoms of intoxication.
It is very important to identify developing diabetic nephropathy in the first three stages, when treatment is still possible to change. In the future you will not be completely cured changes kidneys can only be maintained by further deterioration.
Diagnosis of diabetic nephropathy:
Of great importance is the timely diagnosis of diabetic nephropathy. It is important to identify the initial changes in the early stages.
The main criterion for determining the extent of changes in the early stages is the amount excreted in urine albumin – albuminuria.
Normally, a person is allocated less than 30 mg albumin per day, a condition called normoalbuminuria.
It is important to know that permanent microalbuminuria suggests the development of diabetic nephropathy in the next few years.
The patient should regularly take a urine test to determine the protein to track the changes.
With frequent presence of albumin in a single urine sample must pass daily urinalysis. If it detect the protein in a concentration of 30 mg and the same results will be revealed in a re-analysis of daily urine (two and three months), then put the initial stage of diabetic nephropathy.
At home, you can also monitor the amount allocated to the protein by means of special visual test strips.
In the late stages of diabetic nephropathy is the main criterion for proteinuria (more than 3 g / day), decreased glomerular filtration rate, increased blood pressure. Since the development of profuse proteinuria will be no more than 7-8 years before the development of end-stage diabetic nephropathy.
Treatment of diabetic nephropathy:
Of great importance is the compensation of diabetes. We cannot allow sugar spikes and prolonged hyperglycemia.
It is necessary to normalize blood pressure.
Take measures to improve microcirculation and prevention of atherosclerosis (lower cholesterol, quit smoking).
At later stages needed medications, compliance with a special low-protein diets, and, of course, the normalization of glucose and blood pressure.
In the late stages of renal failure reduces the need for insulin. Must be very careful to avoid hypoglycemia.
Insulin dependent patients in the development of renal failure is transferred to insulin therapy. This is due to the fact that all oral sugar-lowering drugs are metabolized in the kidneys (except Glyurenorma, its use is possible in renal failure).
With increased kreatitnin (500 umol / L and above) is the question of dialysis or kidney transplantation.
Prevention of diabetic nephropathy:
To prevent the development of diabetic nephropathy is necessary to follow certain rules:
- Normalization of blood glucose. It is important to keep blood sugar within normal limits. In those cases, insulin dependent diabetes when diet does not give the desired results, you need a translation to insulin.
- Normalization of blood pressure with antihypertensive therapy at elevated pressure above 140/90 mmHg
- Compliance with low-protein diet in the presence of proteinuria (reduced consumption of protein).
- Compliance with low-carbohydrate diet. Necessary to keep the level of triglycerides (1.7 mmol / l) and cholesterol (less than 5.2 mmol / l) within normal limits.
With the ineffectiveness of diet needed medication, which action is directed at normalizing the lipid composition of blood.