Talk about diabetic nephropathy


  • How kidneys work
  • How to recognize diabetic nephropathy
  • Treatment of diabetic nephropathy

  • How kidneys work

    Amid prolonged decompensation of diabetes in the kidneyaffects small vessels, which are the main part of the renal glomerulus. From the set of the glomeruli and is kidney tissue. The vessels of the renal glomerulus provide kidney function, which is performed in the human body as a filter. Waste substances kidney excreted in the urine, filtered them out of the blood, delaying the desired steered back into the blood.

    But when due to elevated blood sugaraltered glomerular blood vessels, the normal functioning of the kidney filter is broken. Then the protein substance which is desired, and in normal urine misses begins to penetrate.

    How to recognize diabetic nephropathy

    Talk about diabetic nephropathy
    Complications of diabetes on the kidneys - diabetic nephropathy - says the teacher of "diabetes schools" Vyatka Regional endocrinological dispensary TA Rakova.

    - At first, diabetic nephropathy can not berecognize, and in fact it is the leading cause of morbidity and mortality in patients with type I diabetes. Often, this complication develops in patients with type 2 diabetes, chronically ill and poorly compensated.

    - Tatiana, which analyzes the patient need to take regularly?

    - Everyone at least once a year toto pass a urine test for the determination of protein in it. This can be a normal, so-called urinalysis, which is done in any clinic. However, diabetic nephropathy can be detected at earlier stages. To make this content on urine albumin in it.

    Albumin - a protein that is in the blood andNormally urine is practically absent. But even small irregularities in the work of the kidneys increases the amount of albumin, although other proteins in the urine until fall. If at this stage the disease is not stopped, then the loss of protein in the urine will increase.

    Microalbuminuria - albumin excretion in the urineranging from 30 to 300 milligrams per day - may optionally be transient and lead to the development of diabetic nephropathy, but is always preceded and indicates a high risk of chronic renal failure.

    - At the stage of microalbuminuria changes in the kidney may be reversible?

    - It is necessary once in 3 months to do analysisblood glycated hemoglobin to assess diabetes compensation, determined in serum creatinine level and at least once a month to measure blood pressure.

    If the disease has already developed and passed into the stage of proteinuria, the blood and urine studies should be done more frequently - once every 3 - 6 months, and the blood pressure monitor constantly.

    But we must remember that there are a numberthe factors leading to false positive diagnosis of microalbuminuria: glomerulonephritis, urinary tract infection, intense physical activity, menstrual bleeding.

    - Another manifestation of diabetic nephropathy may be an increase in blood pressure?

    - It is not always a result of kidney damage,but high blood pressure in itself causes serious harm to the kidneys. Hypertension accelerates the progression of diabetic nephropathy, and sooner started antihypertensive therapy significantly improves the prognosis of diabetic nephropathy in adult patients. It is assumed that microalbuminuria appears for 2 - 3 years to increase blood pressure, so it is very important is the regular measurement of blood pressure.

    Its increased level regardless of the reasonorigin should be reduced. The maximum allowable is currently considered to be 130 mm Hg for the upper index (systolic) and 80 mm - for the lower (diastolic). If at least one of the two blood pressure figures often above these limits, you need treatment.

    Treatment of diabetic nephropathy

    - Medicines to treat high blood pressure are now very much. And every patient probably can pick up an effective therapy?

    - It is important to the patient to understand that takingthese drugs must be constantly, that is, not only at high but also at decreased to norm blood pressure, so it is not increased. Very useful as a standalone control of blood pressure at home, in particular to evaluate the effectiveness of drugs, so all patients with hypertension, it is desirable to have a home device to measure the pressure and be able to use it.

    - How to treat diabetic nephropathy?

    - In the early stages (microalbuminuria) effectivelythe appointment of drugs - ACE inhibitors, which are appointed in small doses, even with normal blood pressure, in addition, mandatory control of blood sugar levels, teens - complete cessation of smoking. In addition, adult doctor may prescribe a diet low in animal protein. In the later stages of nephropathy when kidney function is impaired, requiring special treatment, up to hemodialysis.

    - Is there a scientific assessment of the prevalence of diabetes complications?

    - Active work on the creation of the Statediabetes register in Russia, carried out under the auspices of the Endocrinology Research Center, allowed to obtain epidemiological data which characterize the prevalence of diabetes mellitus type 1 and 2, and vascular complications in our country. It turned out that the actual incidence of complications, detectable with the active direction of research, many times the precinct to be registered endocrinologists.

    In type 1 diabetes incidenceDiabetic nephropathy is 33 percent, which is twice higher than registered, type 2 diabetes actual prevalence - 25 percent, which is 8 times higher than registered! The findings support the need for large-scale action for the early detection of vascular complications. It is thanks to these measures in European countries in recent years there has been a downward trend in the incidence of diabetic nephropathy in type 1 diabetes.

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