Subscribe
Diabetic nephropathy
How to prevent and treat diabetic nephropathy
The prevention and treatment of diabetic nephropathy include the following 6 aspects: The first is changing lifestyle, including controlling weight, diabetic diet, quitting smoking, quitting alcohol, and appropriate exercise. Changing lifestyle is the foundation of blood sugar control and a key to improving various metabolic disorders. The second is blood sugar control. Strict blood sugar control is the most important means to prevent the occurrence and development of diabetes and diabetic nephropathy. Under normal kidney function, it is recommended to keep glycated hemoglobin below 6.2%. For patients with abnormal kidney function or elderly patients, it can be relaxed to 7%. The third is to reduce blood pressure and proteinuria. The most commonly used medications are ACE inhibitors and angiotensin receptor blockers. Once diabetic microalbuminuria appears, blood pressure should be controlled below 130/80 mmHg. The fourth is to restrict the intake of dietary protein, with a focus on animal protein, i.e., high-quality protein. Early stage protein intake should be controlled at 0.8-1g/kg; for patients who have developed renal failure, controlling protein intake at 0.6-0.8g/kg is more appropriate. The fifth involves controlling other factors, including a low-salt diet and treating hyperlipidemia. The sixth is the treatment of end-stage diabetic nephropathy. Since diabetic nephropathy patients frequently have cardiovascular complications and symptoms of uremia appear earlier, it is appropriate to start dialysis treatment early. (Please take medications under the guidance of a doctor.)
Can diabetic nephropathy with swollen feet be treated?
Diabetic nephropathy in the middle and later stages can cause edema, especially in patients with significant proteinuria or renal failure. Many patients can even experience generalized edema. For such patients, swollen feet and swelling in other parts of the body can be considered for appropriate use of diuretics to increase urine output and eliminate edema. However, generally, the extensive use of diuretics is not actively advocated because excessive diuresis can also lead to significant protein loss and even cause insufficient blood volume, affecting the blood supply to the kidneys. Nevertheless, some patients with severe conditions that cause pulmonary edema and heart failure may not respond well to diuretics. In such cases, dialysis ultrafiltration may be required to remove water, alleviate edema, and reduce cardiac stress.
Can diabetic nephropathy undergo kidney transplantation?
Diabetic nephropathy has now become the leading cause of uremia in China, accounting for the largest proportion. In the 1980s and 1990s, chronic nephritis was the most common cause of uremia in China. Over the past decade, diabetic nephropathy has gradually surpassed chronic nephritis and become the leading condition. This condition requires dialysis or a kidney transplant when it progresses to uremia. Patients with diabetic nephropathy in a uremic state can undergo a kidney transplant. After the transplant, these patients still need to use medications to control their blood sugar and blood pressure, to prevent high blood sugar and high blood pressure from further damaging the new kidney. Of course, if conditions allow, performing a combined kidney and pancreas transplant might yield better results.
What can diabetic nephropathy eat?
Diabetic nephropathy, as the name suggests, is a complication of the kidneys caused by long-term poor control of blood sugar in diabetes. Its most typical symptoms include significant proteinuria and potential body edema. Generally, there is no particularly good method to treat diabetic nephropathy; firstly, it is necessary to control blood sugar well, ensuring that fasting blood glucose does not exceed 7 mmol/L, and blood glucose two hours after a meal does not exceed 10 mmol/L. Additionally, some kidney-protective measures can be used to reduce urinary protein, etc. Furthermore, foods high in sugar, fried foods, and those high in starch should be avoided, such as potatoes, taro, sweet potatoes, and vermicelli, all of which should be consumed less.
Is stage three diabetic nephropathy severe?
Stage three of diabetic nephropathy refers to patients who have persistent microalbuminuria, indicating a relatively mild state of the disease at this time. In fact, diabetic nephropathy is divided into five stages. During the first and second stages, patients generally do not exhibit specific symptoms clinically and may even test negative for proteinuria; however, an increase in kidney size and glomerular filtration rate may occur. By the third stage, patients begin to exhibit small or micro amounts of urinary albumin. The pathological damage to the kidneys at this stage is not considered particularly severe. Patients may experience hyalinization of small arteries and nodular lesions in the glomeruli. Within the staging of diabetic nephropathy, this does not constitute a particularly severe phase; however, the condition of the patients may continue to progress, leading to significant proteinuria and even renal failure.
How to check for diabetic nephropathy?
For the examination of diabetic nephropathy, patients first need to undergo routine urinalysis and check for the urinary albumin excretion rate. Generally speaking, one characteristic of diabetic nephropathy is the presence of urinary protein. A urinary albumin excretion rate between 20 and 200 µg/min is an important basis for diagnosing early diabetic nephropathy. If a patient’s urinary albumin excretion rate consistently exceeds 200 µg/min, significant diabetic nephropathy is often considered. Of course, this is under the assumption that the patient has had diabetes for at least ten years and has diabetic retinopathy. A kidney biopsy is needed for confirmation. Of course, to assess the impact of diabetic nephropathy on kidney function, blood tests for serum creatinine and urea nitrogen are necessary.
How is diabetic nephropathy treated?
The treatment of diabetic nephropathy also depends on the specific stage the patient is in. During stages one to three, the main clinical treatments include controlling blood sugar, blood pressure, and lipids. Patients with diabetes often also have these metabolic disorders, including hypertension and hyperlipidemia, which can damage the kidneys. In addition, in the early stages, some medications are often chosen to reduce the pressure on the glomeruli. For example, using ACE inhibitors or angiotensin receptor blockers (ARBs) and inhibitors of the sodium-glucose cotransporter, these drugs can also slow the progression of kidney failure. However, if the patient's condition has progressed to stage five, which is essentially equivalent to the state of uremia, the patient will then need dialysis treatment.
Treatment of Anemia in Diabetic Nephropathy
Compared to primary chronic nephritis, patients with diabetic nephropathy develop anemia earlier and more severely. The treatment for this type of anemia is divided into two aspects. Firstly, since it is anemia caused by renal lesions leading to a lack of erythropoietin, it is necessary to supplement erythropoietin, as well as iron and folic acid, which are raw materials for blood production, for the anemia caused by diabetic nephropathy. Additionally, patients with diabetic nephropathy are prone to malnutrition and should enhance nutritional support, especially by increasing the intake of high-quality animal protein.
Symptoms of diabetic nephropathy anemia
Patients with diabetic nephropathy who exhibit anemia indicate that they are experiencing relatively severe renal failure. Such patients may show clear clinical symptoms, such as significant edema, excessive proteinuria, and renal failure. The impaired water excretion can lead to swelling in the lower limbs and facial area. The presence of anemia causes fatigue in patients, potentially leading to chronic ischemia and hypoxia in some organs. Symptoms such as listlessness and drowsiness may occur. In the state of anemia due to diabetic nephropathy, the accumulation of metabolic waste may also affect the patient's appetite, causing poor food intake. Additionally, diabetic damage to the retinal arteries can lead to a decline in vision, or even complete blindness.
How to reduce proteinuria in diabetic nephropathy
One major characteristic of patients with diabetic nephropathy is the increase in urine protein, and some patients may even have a large amount of urine protein. The treatment of this disease is indeed quite challenging, and there are not many effective treatments available clinically. In the early stages, when the patient's serum creatinine has not exceeded 256 µmol/L, clinicians often choose ACE inhibitors or angiotensin receptor blockers (ARBs) to reduce the pressure within the glomerulus and decrease urine protein. At the same time, it is recommended for patients to use insulin to control blood sugar. However, in recent years, there has been some progress in the treatment of diabetic nephropathy, such as the use of sodium-glucose cotransporter 2 inhibitors, which may help reduce urine protein. (Medication should be used under the guidance of a clinician, based on the specific condition of the patient.)