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Scout for early renal damage in diabetes -- microalbuminuria

2017-05-28 10:39

Aunt Lee found in diabetes fourth years, microalbuminuria was found in the laboratory, after regular treatment after being restored to the normal level after she was very careful, not only strict control of blood glucose, blood pressure, blood lipid and protein intake, prevention of infection (such as colds, urinary tract inflammation), and every 3 ~ 6 month she would go to the hospital to check a urinary albumin. Now, for 16 years, her condition is well controlled and urinary albumin excretion rates have not increased.

Diabetic nephropathy (DN) is one of the common complications of diabetes. It can be reversed by early stage control and treatment, while the early stage of evidence is the increase in urinary albumin excretion rate, that is microalbuminuria. Urine albumin analysis is a simple and sensitive method for early diagnosis of diabetic nephropathy.

In 1982, when Viberti studied diabetic nephropathy, he proposed the concept of microalbuminuria in order to distinguish it from clinical proteinuria. The WHO (WHO) standards are: 24 hours urine protein content greater than 30 mg or 20 micrograms per minute urine protein, that is, microalbuminuria. Because the urine protein excretion is not constant, but also influenced by the amount of urine, it is also applied to creatinine ratio (urinary creatinine excretion is constant) to determine, such as urine per mg creatinine and discharged 1 discharged more than 30 micrograms of protein (30 g / mg creatinine) also, microalbuminuria. If 24 hours of urine protein exceeds 300 mg, 200 micrograms per minute urine, or 300 micrograms / mg creatinine, is the clinical proteinuria. The extent of microalbuminuria is above the normal range of urinary protein, while conventional protein qualitative chemical methods are not detectable at the stage.

There are many methods of test for protein in urine, but commonly used sulfosalicylic acid, acetic acid and heating test basic cannot detect microalbuminuria, only by immunochemical techniques (such as radioimmunoassay, ELISA and immune nephelometry and immune turbidimetry and other special methods to make the determination of albumin exposed) "". The ideal method is to take 24 hour specimens and determine the urinary albumin excretion rate for 24 hours. If the excretion rate of urinary albumin in urine is up to 2 times within 6 months to reach the diagnostic criteria of microalbuminuria, and other reasons are excluded, it is a marker for the diagnosis of early or occult diabetic nephropathy. Such as the excretion rate at the critical level (20 mg /24 hours), should be in 1 ~ 6 months, collected 3 times 24 hours urinary albumin urine, if 2 times in 30 ~ 300 mg /24 hours or 3 times the average in 30 ~ 300 mg /24 hours, can be diagnosed with microalbuminuria.

Diabetic nephropathy is divided into 5 phases, namely phase 1 (glomerular filtration rate), 2 (normal albuminuria stage), 3 (early diabetic nephropathy stage), 4 (clinical stage diabetic nephropathy or overt diabetic nephropathy stage) and the 5 phase (renal failure stage). In the third stage, there is no typical clinical symptom, and urine albumin can not be detected by routine method. People often think the kidney is not ill. At this point, it is only one step away from the irreversible stage of kidney disease". It is especially important to seize this period, because when clinical albuminuria occurs, treatment is difficult, and further progression to uremia can not reverse the condition and can only be performed on dialysis or kidney transplantation.

For sugar friends, urine micro albumin test should generally be checked once a year for six months, conditional three months to check once, the conditions are limited, at least once a year should be checked. Patients who have been diagnosed with microalbuminuria or kidney disease should go to the hospital regularly for 24 hours of microalbuminuria or routine urine protein under the guidance of a specialist, so as to observe the condition in a timely manner.

Of course, prevention and treatment of diabetic nephropathy is not only check the urinary albumin, need to take various measures to control the nip in the bud, such as blood pressure, blood lipid, blood glucose control, prevention of infection, dietary protein restriction and under the guidance of a doctor taking drugs, to strengthen the doctor-patient communication, do not own or follow it, but don't be afraid. Delayed treatment.

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