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Early screening for diabetic nephropathy

2017-03-31 18:16
Diabetic nephropathy is one of the most important factors in the etiology of adult chronic renal failure. In the United States each year, about 50% of patients with hemodialysis are diabetic nephropathy. Type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) can occur diabetic nephropathy, T1DM patients have a higher incidence of diabetic nephropathy, it is 30%% - 40%. About 34.7% of T2DM patients have diabetic nephropathy. So early detection of diabetic nephropathy is very important. Diabetic nephropathy can be divided into the following five stages:
Ⅰ stage: Glomerular filtration rate increased, renal volume increased, renal blood flow, glomerular capillary perfusion pressure and internal pressure increased. Glomerular basement membrane and mesangial are normal. After proper treatment can restore.
Ⅱ stage: the normal albuminuria period. Glomerular filtration rate was normal or increased, urinary albumin excretion rate was normal (less than 20 microgramme / min or 30 mg /24 hours), after exercise or stress, the excretion increases, removing the inducement to return to normal. Glomerular basement membrane thickened and mesangial matrix increased. More blood pressure are normal.
Ⅲ stage: Early diabetic nephropathy. The glomerular filtration rate was approximately normal, the excretion rate of urinary albumin was higher than normal, and the blood pressure was increased slightly. Glomerular basement membrane thickening and mesangial matrix increasing are significant, there were glomerular nodular and diffuse lesions and small artery hyaline degeneration, and began to appear glomerular waste. This period of patients have mild blood pressure increasing, blood pressure reduced can partly reduce the excretion of urine microalbumin.
Ⅳ stage: Clinical diabetic nephropathy. A lot of albumin, urine protein quantitation consistently greater than 0.5 grams for every 24 hours was non selective proteinuria, severe proteinuria is more than 3.5 grams per 24 hours, appeared hypoalbuminemia, edema and hypertension, often with varying degrees of nitrogen retention and diabetic retinopathy. The glomerular basement membrane was further thickened, the mesangial matrix increased, and the glomerulus was abandoned.
V stage: end-stage renal failure. Urinary protein excretion  reduced due to glomerular obsolescence, glomerular filtration rate is less than 10 ml / min, with hypertension, hypoalbuminemia, edema, blood creatinine and urea nitrogen increased, loss of appetite, nausea and vomiting and anemia, metabolic acidosis, hypocalcemia and hyperkalemia, can secondary uremic neuropathy and myocardial lesions.
At the five stages, the critical stage is the Ⅲ stage: early diabetic nephropathy is the first discovery of diabetic nephropathy stage, so at this time, the effective intervention treatment can effectively prevent the further development of diabetic nephropathy. In the early stages of Diabetic nephropathy often do not have obvious symptoms. Generally, it is already in the middle or late stages when the patients found the disease, and bring difficulties to the treatment. So we have to carry out the screening of urinary microalbumin for every incipient type 2 diabetes and more than 5 years of type 1 diabetes patients in order to do early diagnosis, early treatment, early benefit.
 

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