Sugar diabetes disease is not new and many familiar, alas, not by the hears. But not everyone knows that this severe illness still has complications, and one of them is diabetic nephropathy. How to recognize and treat diabetic nephropathy? Listen to the expert.
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But when, due to elevated blood sugar, the vessels of kidney glomers change, the normal functioning of the renal filter is broken. Then the protein that is the necessary substance, and in the norm in the urine does not fall, starts to penetrate there.
On the complication of diabetes for kidneys - diabetic nephropathy - Teacher tells «School diabetes» Vyatka Regional Endocrinological Dispensary T.BUT. Rakov.
- At first, diabetic nephropathy can not be recognized, and it is the leading cause of morbidity and mortality of patients with type I diabetes. Often this complication develops in patients with diabetes 2 types, long-friendly and poorly compensated.
- Tatyana Anatolyevna, what tests the patient must be taken regularly?
- Each at least once a year it is necessary to pass urine analysis to determine protein in it. It can be the usual, the so-called urine overall analysis, which is done in any clinic. However, you can reveal diabetic nephropathy and earlier stages. For this make urine analysis for the content in it albumin.
Albumin - protein, which is in the blood and is almost absent in the urine in the urine. But with already small disorders in the work of the kidney, the amount of albumin increases, although other proteins in the urine do not yet fall. If at this stage does not stop the disease, then the losses of proteins with urine will increase.
Microalbuminuria - allocation of albumin with urine ranging from 30 to 300 milligrams per day - can be transient and optionally lead to the development of diabetic nephropathy, but it always precedes it and indicates a high risk of chronic renal failure.
- At the stage of microalbuminuria, the kidney changes can be reversible?
- It is necessary to make blood test once every 3 months to assess diabetes compensation, determine the level of creatinine and at least once a month to measure blood pressure.
If the disease has already developed and switched to the stage of proteinuria, then blood and urine studies should be done more often - once every 3 - 6 months, and blood pressure control constantly.
But it is necessary to remember that there are a number of factors leading to a false-positive diagnosis of microalbuminuria: glomerulonephritis, urinary tract infection, intense physical exertion, menstrual bleeding.
- Another manifestation of diabetic nephropathy can be improved blood pressure?
- This is not always a consequence of kidney defeat, but the increased pressure in itself causes the kidney to be serious. Arterial hypertension accelerates the progression of diabetic nephropathy, and early initiated hypotensive therapy significantly improves the forecast of the course of diabetic nephropathy in adult patients. It is assumed that the microalbuminuria appears in 2 - 3 years before an increase in blood pressure, therefore, the regular dimension of blood pressure is very important.
Its elevated level, regardless of the causes of the occurrence, it is necessary to reduce. 130 millimeters of mercury pillar for top indicator (systolic) and 80 mm are considered extremely permissible - for the lower (diastolic). If at least one of these two blood pressure indicators often turns out to be higher than the specified limits, treatment is necessary.
- It is important to understand the patient himself that it is necessary to take these drugs constantly, that is, not only with high, but also with a decreased to the norm by arterial pressure so that it does not increase. It is also very useful to independent control of blood pressure at home, in particular to assess the effectiveness of the preparations taken, so all patients with arterial hypertension are desirable to have a home apparatus for measuring pressure and be able to use them.
- How to treat diabetic nephropathy?
- At an early stage (microalbuminuria), the appointment of drugs - ACE inhibitors, which in small doses are appointed even under normal arterial pressure, in addition, control over blood sugar levels, adolescents - a complete refusal of smoking. In addition, an adult doctor may assign a diet with a reduced content of animal proteins. In the later stages of nephropathy, when kidney functions are broken, special treatment is required, up to hemodialysis.
- Is there a scientific estimates of the prevalence of complications of diabetes?
- Active work on the creation of a state register of diabetes in Russia, conducted under the auspices of the Endocrinological Scientific Center, made it possible to obtain epidemiological data characterizing the prevalence of diabetes mellitus 1 and 2 types and vascular complications in our country. It turned out that the actual prevalence of complications detected with an active directional study, many times higher than the regional endocrinologist registered.
In type 1 diabetes mellitus, the prevalence of diabetic nephropathy is 33 percent, which is two times higher than the actual prevalence in diabetes, 25 percent, which is 8 times higher than the registered! The data obtained confirm the need for large-scale actions for early detection of vascular complications. Thanks to these measures, in Europe, there has been a tendency to reduce the frequency of development of diabetic nephropathy with diabetes mellitus 1.
