Combined with years of clinical experience, this problem can be completely cured. The key is to receive reasonable treatment. Type 2 diabetic nephropathy is a kind of kidney disease. Compared with type 1 diabetic nephropathy, the cure rate is higher and the treatment method is simpler. Generally speaking, 1 type diabetic nephropathy is harmful and has a short onset time, so it will be more difficult for us to treat it. With active treatment, diabetic nephropathy can be cured.
The treatment of diabetic nephropathy is to control diabetes and avoid the occurrence of renal lesions. The level of blood sugar control has an extremely important influence on the occurrence and development of diabetic nephropathy and diabetic fundus lesions.
2. Diabetic nephropathy examination
Urine sugar qualitative
Screening diabetes is a simple method, but there may be false negative or false positive in diabetic nephropathy, so measuring blood sugar is the main basis for diagnosis.
Urinary albumin excretion rate
20~200? G/min is an important index for the diagnosis of early diabetic nephropathy. When the UAE continues to be greater than 200? G/min or positive urine protein routine examination (urine protein quantitative greater than 0.5g/24h) was diagnosed as diabetic nephropathy.
Urine sediment
Generally, when the change is not obvious, white blood cells often indicate urinary tract infection; A large number of red blood cells suggest that hematuria may be caused by other reasons.
Urea nitrogen and creatinine
In the late stage of diabetic nephropathy, the clearance rate of endogenous creatinine decreased, and blood urea nitrogen and creatinine increased.
3. Causes of diabetic nephropathy
Abnormal renal hemodynamics can be observed in the early stage of diabetic nephropathy, characterized by high glomerular perfusion and high filtration, and increased renal blood flow and glomerular filtration rate (GFR), especially after increasing protein intake.
hypertension
Almost all diabetic nephropathy is accompanied by hypertension, which occurs in parallel with microalbuminuria in type 1 diabetic nephropathy, and often occurs before diabetic nephropathy in type 2 diabetic nephropathy. Blood pressure control is closely related to the development of diabetic nephropathy.
Abnormal metabolism of vasoactive substances
During the occurrence and development of diabetic nephropathy, there may be metabolic abnormalities of various vasoactive substances. Including metabolic abnormalities such as RAS, endothelin, prostaglandin family and growth factors.
Stage ⅰ of diabetic nephropathy: no obvious symptoms, but renal function examination can find that glomerular filtration rate is increased.
The second stage of diabetic nephropathy: the patient still has no obvious symptoms, and the urinary protein excretion rate is normal at rest, that is,
The third stage of diabetic nephropathy: also known as the early stage of diabetic nephropathy, from this stage, patients began to show obvious abnormalities, and renal function examination showed persistent microalbuminuria, that is, the urinary protein excretion rate continued at 20-200 μ g/min, marking this stage, but the routine urine protein was still negative.
The fourth stage of diabetic nephropathy: clinical nephropathy stage, characterized by massive proteinuria and urinary protein excretion rate >; 3.5g/ day, the urine routine protein is positive, and the patient can find typical proteinuria when urinating, that is, there are many urine bubbles, and the bubbles cannot dissipate for a long time.
The fifth stage of diabetic nephropathy: that is, the fifth stage is renal failure stage, which is often called end-stage renal disease in clinic. From a large number of proteinuria, the patient's renal function deteriorated rapidly until renal failure.
Dietary treatment restriction of diabetic nephropathy in protein: Patients with diabetic nephropathy should limit the intake of protein at an early stage and give a low-protein diet. The intake of protein in patients with clinical diabetes should be limited to 0.8g/kg body weight per day, and the intake of protein in patients with renal insufficiency should be limited to 0.6g/kg body weight per day. In addition, when patients are in the late stage of renal insufficiency, low-protein diet should not be adopted to prevent malnutrition in protein. Patients receiving hemodialysis or peritoneal dialysis should increase their intake of protein, and the intake of protein is per kilogram of body weight 1.2g per day.
Essential amino acid therapy: Essential amino acid therapy means that patients should not only absorb essential amino acids through diet, but also orally or intravenously inject essential amino acid preparations. This is because even if high-quality protein is ingested, its essential amino acid content is less than 50%. If essential amino acid preparations are used, the daily dosage of adults is 12g ~ 23g, which can ensure the amount of amino acids needed by human body.
Intake enough calories: When the patient's calorie intake is insufficient, glycogen dysplasia will increase, protein and amino acid decomposition will accelerate, resulting in negative nitrogen balance and increased urea nitrogen concentration. Therefore, patients should be given enough calories in their diet.