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Diabetic nephropathy
Is early diabetic nephropathy reversible?
Diabetic nephropathy clinically mainly manifests as an increase in urine protein on routine urine tests. Thus, diabetic nephropathy can be classified into different stages. In the early stages, microalbuminuria appears, and at this early phase, diabetic nephropathy is actually reversible. However, if the condition progresses with significant proteinuria, it becomes difficult to reverse diabetic nephropathy through intervention treatments. Most clinical patients may experience a slight reduction in urine protein or maintain this condition long-term without further progression. However, some patients have already experienced an increase in creatinine levels by the time they reach this stage of diabetic nephropathy, making it particularly challenging to reverse the condition once creatinine levels rise. Therefore, for diabetic nephropathy, early detection and treatment are crucial, with the most important goal being the prevention of the disease's onset.
What should I do if diabetic nephropathy causes facial swelling?
Diabetic nephropathy with facial swelling is generally due to too much protein in the urine and too little protein in the blood, causing hypoalbuminemia, which leads to edema. There are several methods to control diabetic nephropathy: First, blood sugar and blood pressure must be strictly controlled within a normal range. Blood pressure control should be even stricter for those with diabetic nephropathy, generally kept below 130/80. Second, in terms of diet, it is crucial to avoid or limit intake of bean-based foods and consume high-quality proteins instead. High-quality proteins include commonly known meats, eggs, and fish. Third, it is essential to limit or avoid the use of medications that can damage the kidneys. Fourth, if diabetic nephropathy causes general body edema, intermittent use of diuretic medications can help alleviate the swelling, along with nephroprotective medications. The final method for severe kidney disease involves early intervention with hemodialysis or peritoneal dialysis. (Please use medications under the guidance of a doctor)
What are the symptoms of diabetic nephropathy?
The symptoms of diabetic nephropathy mainly include the following aspects: The first one is proteinuria, where patients may notice an increase in foam in their urine, and upon examination, proteinuria will test positive. The second symptom is edema, which may initially appear as intermittent swelling but gradually develops into swelling of both lower extremities or even the entire body. Of course, pleural effusion and ascites may also occur. The third type of symptom is hypertension; diabetic nephropathy combined with hypertension often involves stubborn high blood pressure, which requires multiple antihypertensive drugs to control. The fourth point is that in the later stages of diabetes, signs of renal failure gradually appear, such as nausea, vomiting, difficulty breathing, anemia, renal osteopathy, skin itching, and more. The fifth is extrarenal manifestations, such as diabetic retinopathy presenting with vision loss or even blindness, and diabetic neuropathy leading to numbness and abnormal sensations in the hands and feet. Additionally, it is common for patients with diabetic nephropathy to also experience cardiovascular and cerebrovascular complications, such as coronary heart disease, myocardial infarction, stroke, and more.
Does diabetic nephropathy cause back pain?
Diabetic nephropathy generally does not cause symptoms of back pain. Diabetic nephropathy refers to patients with long-term hyperglycemia, typically those whose blood sugar has been elevated for ten years or more, causing damage to the small blood vessels. The kidneys, being rich in small blood vessels, undergo glomerular sclerosis. Early in the disease, patients experience an increased glomerular filtration rate. As the condition progresses, proteinuria gradually increases. When proteinuria occurs, patients may exhibit noticeable edema, and in some cases, patients may develop severe edema due to substantial proteinuria, leading to serious complications like pulmonary edema and heart failure, which manifest as respiratory difficulties and chest tightness. However, these conditions do not cause back pain, even though there is glomerular sclerosis, as patients do not feel any pain associated with it.
Is diabetic nephropathy dialysis painful?
Whether it is diabetes, nephritis, high blood pressure, or other causes leading to kidney failure, it may eventually progress to uremia. Patients with such conditions need dialysis or a kidney transplant to survive. Generally, patients undergoing any type of dialysis do not experience significant pain symptoms. Dialysis can be divided into hemodialysis and peritoneal dialysis, both of which use artificial methods to remove metabolic waste from the patient's body and maintain the stability of the internal environment. These methods generally do not involve significant traumatic procedures, so they mostly do not cause notable pain. However, patients undergoing hemodialysis may need temporary needling each time, which causes minimal trauma and typically does not result in severe pain or significant discomfort.
Early symptoms of diabetic nephropathy
Diabetic nephropathy is divided into five stages. In the first and second stages, patients generally do not have significant proteinuria. At this time, the pressure inside the glomeruli increases, and the glomerular filtration rate actually increases, which may result in an increase in kidney size. During this period, patients generally do not have obvious symptoms, and it is difficult to detect without detailed examination. By the third stage, patients develop proteinuria, which increases as the disease progresses, and patients may notice an increase in urine foam. When diabetic nephropathy reaches the stage with proteinuria, a prominent clinical symptom is edema. This edema initially appears in the bilateral facial and lower limb areas. As the disease progresses, some patients may also experience generalized edema, and can develop effusion in the pericardium, thoracic cavity, and abdominal cavity. Symptoms such as chest tightness, shortness of breath, difficulty breathing, pulmonary edema, and heart failure may occur.
Symptoms of stage 2 diabetic nephropathy
Diabetic nephropathy is divided into five stages. Speaking in terms of the severity of the condition, in the second stage, the clinical manifestations are not very obvious, and the patient's kidney size may increase. Generally, at rest, the patient's urine protein is negative, but after activity, there might be traces of albumin in the urine. Due to the presence of a small amount of protein in the urine, there may be an increase in urine foam, and the patient may experience mild edema, although the symptoms of this edema are also not very noticeable. At this stage, the damage of diabetes to other organs of the body is not very evident, therefore, retinopathy is not severe, and the patient’s vision decline is not significant. The patient may also have concurrent issues like hypertension and hyperlipidemia.
Is diabetic nephropathy with facial swelling serious?
Patients with diabetic nephropathy who experience facial swelling should not use this symptom as a basis for judging the severity of their condition. Diabetic nephropathy is divided into five stages. The condition is relatively mild during the first three stages. By the fourth stage, patients begin to exhibit significant proteinuria, and by the fifth stage, they experience severe renal failure. Conditions in these last two stages are quite severe. However, patients might also experience facial swelling during the first three stages, and while the likelihood of facial swelling increases during the fourth and fifth stages, some patients in these stages might not show obvious edema. Therefore, it is difficult to determine the severity of the condition based solely on swelling. Patients need to undergo 24-hour urinary protein quantification and blood tests to assess kidney function in order to judge the severity of their condition.
How to reduce proteinuria in diabetic nephropathy.
A major clinical feature of diabetic nephropathy is the occurrence of proteinuria, which, if the condition continues to progress, can lead to kidney failure. Controlling proteinuria in the early stages of the disease is indeed very important. In terms of treatment, it is primarily necessary to use medications or insulin to control the patient's blood sugar, as hyperglycemia is the fundamental cause of diabetic nephropathy. Additionally, these patients often also have hypertension, necessitating the use of antihypertensive drugs to control blood pressure. When the patient's kidney function is not severely impaired, ACE inhibitors or ARBs can be the preferred choice of antihypertensive drugs, as they not only control blood pressure but also reduce proteinuria. However, if the patient's serum creatinine is significantly elevated, such as over 264 µmol/L, these drugs should no longer be used. (Medications should be used under the guidance of a doctor.)
Is diabetic nephropathy stage 3 reversible?
Patients with diabetic nephropathy actually have an irreversible condition. If a patient has developed mild to moderate proteinuria and entered stage three, it's generally because of long-term high blood sugar, oxidative stress, and an excess of glycation end products damaging the capillaries of the glomerulus, resulting in increased permeability and the occurrence of proteinuria. The damage that has already occurred cannot be reversed; however, patients still need active treatment to control their blood sugar and blood pressure in order to slow down the progression of diabetic nephropathy as much as possible. Stage three diabetic nephropathy is incurable, but treatment can slow the progression of the kidney disease, preventing the development from microalbuminuria to macroalbuminuria. Stage three refers to the early period of diabetic nephropathy, typically seen in diabetic patients who have had the disease for more than five years. It can feature a continuous increase in urinary albumin excretion rates. High filtration rates and long-term poor metabolic control may be reasons for the persistent microalbuminuria. During this stage, patients may experience a mild increase in blood pressure, and reducing blood pressure can decrease the excretion of microalbumin. During this period, strict control of blood sugar is necessary. Oral hypoglycemic drugs can be used for treatment, and it's crucial to regularly monitor fasting blood glucose, postprandial blood glucose, and glycated hemoglobin. Blood pressure should also be actively controlled, generally targeting a value of 130/80mmHg. Angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists are preferred as they can lower blood pressure, reduce proteinuria, and have a protective effect on the kidneys, thus delaying the progression of kidney disease.