Diabetic Nephropathy - Causes, Symptoms and Treatment .MF .
Diabetic nephropathy - the defeat of the renal vessels that occurs in diabetes, which is accompanied by the substitution of dense connective tissue (sclerosis) and the formation of kidney failure.
Causes of diabetic nephropathy
diabetes - a group of diseases that occur due to a defect formation or action of insulin, and are accompanied by a persistent increase in blood glucose levels.This releases diabetes type I (insulin-dependent) diabetes and type II (non-insulin).Prolonged exposure to high glucose levels on blood vessels and nerve tissue organs having the structural changes that lead to the development of diabetic complications.Diabetic nephropathy is one of these complications.
In diabetes type I mortality from renal failure is in the first place, in type II diabetes is second only to cardiovascular disease.
Increased blood glucose is the main precipitating factor in the development of nephropathy.Glucose has not only a toxic effect on the renal vascular cells but also activate some of the mec
Renal vessels in diabetes.
Also of great importance for the formation of diabetic nephropathy is the pressure increase in the renal blood vessels.This is a consequence of inadequate regulation in diabetic neuropathy (nervous system damage in diabetes mellitus).At the end of the damaged vessels are replaced by scar tissue, greatly disturbed kidney function.
Symptoms of diabetic nephropathy
in the development of diabetic nephropathy distinguish several stages:
I stage - renal hyperfunction. arises in the opening of diabetes.Kidney cells several vessels increase in size, increases urine excretion and filtration.Protein in the urine is not determined.External symptoms are absent.
II stage - initial structural changes. There is an average of 2 years after the diagnosis of diabetes.It is characterized by the development of renal vascular wall thickening.Protein in the urine is not well defined, i.e. the excretory renal function is not affected.Symptoms of the disease are absent.
With the passage of time, usually five years, there III stage of the disease - beginning diabetic nephropathy .Typically, when the scheduled inspection or in diagnosing other diseases in urine is determined by small amounts of protein (30 to 300 mg / day).This condition is called microalbuminuria.The appearance of protein in the urine indicates significant kidney damage blood vessels.
mechanism of occurrence of protein in the urine.
At this stage, there is a change in glomerular filtration rate.This indicator shows the filtering of water and low molecular weight pollutants through the kidney filter.In early diabetic nephropathy glomerular filtration rate can be a normal or slightly elevated pressure due to an increase in the renal blood vessels.External symptoms of the disease are absent.
These three stages are called preclinical, as there are no complaints, and damage to the kidneys is determined only by special laboratory methods or microscopy kidney tissue biopsy (sampling of the body for diagnostic purposes).But detection of the disease in these stages is very important, since it is only at this time the disease is reversible.
IV stage - expressed diabetic nephropathy occurs in 10-15 years from the occurrence of diabetes and is characterized by a bright clinical manifestations.With a large amount of urine protein.This condition is called proteinuria.The blood protein concentration is sharply reduced, developed massive swelling.With a little proteinuria swelling occur in the lower extremities and face, followed by progression of the disease become widespread edema, fluid accumulates in the body cavities (abdominal, thoracic cavity, the pericardial cavity).If you have a pronounced kidney damage diuretics for the treatment of edema become ineffective.In this case, resort to surgical removal of fluid (puncture).To maintain optimum blood levels of the protein the body begins to break down its own proteins.Patients lose weight much.Patients also complain of weakness, drowsiness, nausea, loss of appetite, thirst.At this stage, almost all patients notice an increase in blood pressure, sometimes to high numbers, accompanied by headache, shortness of breath, pain in the heart.
V stage - uremic - finals of diabetic nephropathy , end-stage renal failure.Kidney Vessels completely creating sclerosis.The kidney is not doing its excretory function.Glomerular filtration rate - less than 10 ml / min.Symptoms of the previous stage remain and take life-threatening character.The only way it becomes renal replacement therapy (peritoneal dialysis, hemodialysis) and transplantation (persadka) kidney or complex kidney-pancreas.
diagnosis of diabetic nephropathy
Routine tests do not diagnose the preclinical stage of the disease.Therefore, all patients with diabetes demonstrated determination of urine albumin special methods.Detection of microalbuminuria (30 to 300 mg / day) indicates the presence of diabetic nephropathy.A similar importance is the determination of the glomerular filtration rate.Increased glomerular filtration rate indicates an increase in the pressure vessels of the kidneys, which indirectly indicates the presence of diabetic nephropathy.
clinical stage of the disease characterized by the appearance of significant amounts of protein in the urine, hypertension, vascular lesions of the eye with the development of visual impairment and progressive persistent reduction in the glomerular filtration rate of glomerular filtration rate is reduced by an average of 1 ml / min every month.
V stage of the disease is diagnosed by reduction of glomerular filtration rate of less than 10 ml / min.
Treatment of diabetic nephropathy
All activities for the treatment of diabetic nephropathy are divided into 3 stages.
1. Prevention of renal vessels in diabetes.This is possible while maintaining the optimal level of blood glucose due to a competent destination antidiabetic drugs.
2. In the presence of microalbuminuria as a priority is to maintain normal blood sugar levels, as well as the treatment of arterial hypertension, which often occurs already at this stage of the disease.Optimal treatments for high blood pressure are considered inhibitors of angiotensin converting enzyme (ACE) inhibitors, such as enalapril, in small doses.Also, great importance has special diet with a maximum content of protein is not more than 1 g per 1 kg of body weight.
3. When proteinuria main goal of treatment is to prevent the rapid decline in kidney function and the development of end-stage renal failure.The diet introduced tougher restrictions on the protein content in food: 0.7-0.8 g per 1 kg of body weight.At low protein content of the food can occur decay own proteins.Therefore, with the aim of substitution possible appointment of ketone analogs of amino acids, for example, ketosteril.It remains urgent to maintain an optimal level of blood glucose and high blood pressure correction.For ACE inhibitors added calcium channel blocker (amlodipine) or beta-blockers (bisoprolol).When edema prescribe diuretics (furosemide, indapamide) and control the amount of fluid you drink, about 1 liter per day.
4. With a decrease in glomerular filtration rate less than 10 mL / min is a renal replacement therapy or transplantation (transplant) bodies.Currently, renal replacement therapy is presented by methods such as hemodialysis and peritoneal dialysis.But the best way to treat end-stage diabetic nephropathy is a kidney transplant complex-pancreas.By the end of 2000, conducted more than 1,000 successful transplants in the United States.In our country, a complex transplant organs is under development.
physician therapist, nephrologist Sirotkin EV