(a) the harm of diabetic nephropathy
1. bladder weakness, cystitis
The harm of diabetic nephropathy induced bladder weakness, causing cystitis. Bladder weakness is a common problem in patients with diabetic nephropathy problems, often extending in diabetes, especially patients with good diabetes control, due to local neurological disorders, the muscle control bladder contraction failure. Bladder weakness, often makes the urine can not be excluded clean, and urinary retention, bacteria are easily in the retention of urine in the bladder and reproduction, resulting in cystitis.
The harm of diabetic nephropathy can cause cystitis, pyelitis. Urinary system in the kidney to the bladder, are prone to chronic complications in patients with diabetic nephropathy. Part of diabetes, especially in poorly controlled patients, due to impaired phagocytosis of white blood cells of bacteria, the bacteria invasion resistance is poor, it is easy to happen if the bacteria from the bladder cystitis. Extending up, or with the blood circulation to the kidneys, may cause bacterial infection of the kidney is the most common pelvic inflammation, the recurrent acute inflammation, if bacteria did not eradicate it, it may turn into chronic inflammation, the kidney and bladder function slowly corrode role.
3. glomerular sclerosis, uremia
The harm of diabetic nephropathy can lead to glomerular sclerosis, causing uremia. In diabetic nephropathy patients, generally susceptible to a kidney disease as "glomerular sclerosis", there are tens of thousands of kidney in charge of urine for patients with glomerular filtration. Occurrence of hardening phenomenon, no waste excretion, resulting in diabetes and uremia. This is a fairly high rate of chronic complications, and serious complications in patients with diabetes, kidney urinary system, therefore, to pay special attention to. While others such as renal tubules, renal papillary inflammation, its incidence is low.
(two) the principle of prevention of diabetic nephropathy
1. blood glucose control
Active treatment of diabetes, effective blood glucose control in the normal range or close to the normal range, and active treatment of diabetic complications, such as hypertension, urinary tract infection, nerve vascular disease, which is one of the most important measures for the prevention of diabetic nephropathy.
2. diabetes can cause kidney disease early diagnosis, early treatment
Diabetic nephropathy to achieve early diagnosis and early treatment of diabetes. Once to do regular blood glucose, urine routine examination, microalbuminuria to timely treatment, to prevent the development of severe kidney disease, which is an important principle of.[page] prevention of diabetic nephropathy
(three) diet in patients with diabetic nephropathy should follow the rules of what
Diabetic diet is very complex, both to ensure adequate calories and nutrition, but also appropriate to limit carbohydrates, saturated fat and protein. But if what all don't eat, long-term intake of inadequate nutrition will make the body more frail, unable to fight against the disease and poor prognosis. This determines that day is from you for the diagnosis of diabetic nephropathy, your diet and normal diet of diabetic patients are very different, mainly in the following aspects:
1. limit protein intake
The long-term high protein diet intake will increase renal hyperfiltration, while increasing the production and retention of toxic substances, causing further damage to renal function. The general proposition daily dietary protein with 0.6 g / kg standard weight given, but also improve the quality of protein proportion in the limited range. When the development of uremia. Protein restriction should be more strict. Can be used as the main energy source of wheat starch, instead of rice and flour. The wheat starch production is not easy, is also available on the market sales of corn starch, sweet potato starch instead. Long term low protein diet may lead to malnutrition by oral administration of some drugs (such as contract) to the treatment, these drugs can not only increase in kidney loads cause the body essential and non essential amino acids are added to the body protein The synthesis of adequate supplies of raw materials.
2. in the low protein diet when heat supply must be sufficient to maintain the normal physiological life
You can choose some staple foods, high in calories and low protein content like potatoes, taro, lotus root starch, vermicelli, sweet potato, yam, pumpkin, water chestnut powder, water chestnut powder, the total calorie intake reached the standard range.
3. to reduce the intake of fat and salt.
Diabetic nephropathy is often associated with fat metabolism disorders, so still have to adhere to a low fat intake, olive oil, peanut oil rich in monounsaturated fatty acids, can be used as a source of energy. Diabetic nephropathy develops to a certain stage often appear to reduce hypertension, edema or urine volume, restricting the development of salt can effectively prevent complications.
(four) the prevention of diabetic nephropathy to do "five control"
1. blood glucose control
Chronic hyperglycaemia is an important cause of vascular complications of diabetes mellitus, good glycemic control can significantly reduce the risk of diabetic nephropathy, blood glucose control on delaying diabetic nephropathy is extremely important. The clinical commonly used oral hypoglycemic drugs include five categories: sulfonylurea hypoglycemic mechanism, mainly to promote the secretion of insulin; double guanidine, a major role in islet tissue, inhibit the absorption of glucose in the intestinal wall, inhibition of gluconeogenesis; alpha glucosidase inhibitor, mainly by alpha glucosidase inhibitory activity of small intestine, slow the absorption of monosaccharides and oligosaccharides; insulin sensitizing agent, recently found two thiazolidine ketone derivatives has increased insulin sensitivity the role of thiazolidines two ketones of pioglitazone and rosiglitazone can reduce insulin resistance, the latter with the peroxisome proliferator activated receptor 7 binding The improvement of beta cell function; non sulfonylurea insulin secretagogues, can make the rapid release of insulin, effectively reduce postprandial blood glucose before each meal immediately orally, also called prandial glucose regulator.
2. blood pressure control
Hypertension can cause kidney damage and kidney damage will aggravate hypertension. In the early stage of diabetes, treatment of hypertension may be more important than glucose control, but at the same time. Both diabetes and hypertension, choice of angiotensin converting enzyme inhibitor (ACEI) treatment of.ACEI can be used in different periods of diabetic nephropathy in diabetic patients.ACEI can not only protect renal glomerular hyperfiltration state reversal of diabetic nephropathy and does not depend on the initial drop in blood pressure and microalbuminuria can reduce or prevent diabetes. The clinical proteinuria in diabetes, ACEI can also delay the deterioration of renal function, and can improve insulin sensitivity but had no effect on lipid metabolism.
3. control blood lipids
Hyperlipidemia is a metabolic disorder of diabetes outstanding. Hyperlipidemia not only directly involved in the process of islet beta cell damage, but also the effect of low density lipoprotein in mesangial cells on low density lipoprotein receptor, leading to mesangial cells and podocytes injury, increased proteinuria and glomerular and the progression of the tubulointerstitial fibrosis. Recent studies show that statins have hypolipidemic other kidney protective effect. The preferred statins can effectively reduce hyperlipidemia, but also regulate improve endothelial function by its anti inflammation and immunity, reduce cardiovascular complications.
4. control of proteinuria
Proteinuria is not only the clinical manifestations of diabetic nephropathy, but also promote the sign of worsening renal function and increased cardiovascular events. Control proteinuria is to delay the progress of diabetic nephropathy and one of the important measures of.ACEI ARB (angiotensin I receptor antagonist) is the main drug control diabetic nephropathy proteinuria. Natural drugs have been widely used. Tripterygium wilfordii has a strong anti-inflammatory effect, can reduce capillary permeability, negative charge barrier to improve and restore the glomerular filtration membrane, the protein leakage decreased significantly. The traditional Chinese medicine ginseng, astragalus, Chinese yam, Chinese rhubarb can improve blood viscosity, blood glucose, blood lipids, improve renal microcirculation, reduce urinary protein, reduce renal damage. The protection of renal function.
5. control diet
Due to the high protein diet in the nitrogen increased, increased glomerular filtration rate, increase the damage of kidney and so on has become in patients with diabetic nephropathy, suggest a low protein diet. The benefits of low protein diet on patients with diabetic nephropathy is mainly manifested in: reduce urinary protein excretion and improve protein metabolism, delaying the progress of kidney damage; reduce insulin resistance and improve carbohydrate metabolism, improving fat metabolism.