Treatment of diabetic nephropathy2017-02-02 16:51
The treatment of diabetic nephropathy should be comprehensive treatment, emphasizing prevention and early treatment. There should be a concept that when patients with diabetes, in the treatment of diabetes at the same time, we must consider the prevention of diabetic nephropathy. Actively control blood sugar, regularly check the urinary albumin excretion rate, control blood pressure, reduce urinary protein excretion. 1 control of blood glucose in diabetic nephropathy is affected by many factors, including hyperglycemia is an extremely important factor. The relationship between elevated blood glucose and diabetic nephropathy is self-evident. Experimental and clinical studies have shown that good glycemic control can significantly reduce the incidence of diabetic nephropathy. Therefore, it is essential to control blood sugar. A large number of clinical and animal experiments have shown that, in the presence of diabetic kidney hypertrophy and high filtration state, timely control of blood glucose, correct metabolic disorders, kidney hypertrophy and high filtration state can be partially restored. The increase of glomerular filtration rate in early stage of diabetic nephropathy is consistent with the increase of glycosylated hemoglobin. Therefore, the control of blood sugar is the basis for the treatment of diabetic nephropathy. The treatment should take diabetes education, diet therapy, appropriate exercise, drug therapy and blood glucose monitoring and other means, as far as possible to make blood sugar control close to normal. For example, try to make glycosylated hemoglobin < < 7% > > > < < < < < < < < < < < < < < < < < < < < < < < < < < < < 8.0mmol/L > > > > > < < 2H > >, at the same time, pay attention to avoid hypoglycemia. The main measures include diet therapy and drug treatment.
(1) diet therapy for diabetic nephropathy: the treatment of diabetic nephropathy has its particularity, the total calorie intake should be determined according to the patient's height, weight and activity. Special attention should be paid to protein intake in the composition of nutrients. In diabetic nephropathy, the glomerulus is in a state of high filtration, and the high protein diet can cause the high filtration state to continue, and aggravate the changes of glomerular hemodynamics. Therefore, it is advocated that the intake of protein should be limited in the early stage of diabetic nephropathy. Glomerular filtration load. General 0.8g/ (kg * d) protein is more appropriate. For patients who have entered the clinical stage, there is edema, proteinuria, renal damage, according to the endogenous creatinine clearance rate to arrange the intake of protein. The protein intake of patients must be high quality protein, which must be high protein content of amino acids.
(2) oral hypoglycemic agents for diabetic nephropathy should be considered the choice of the metabolic pathway: glibenclamide (glyburide), gliclazide (Diamicron) activity of metabolites were mainly excreted by the kidneys. Kidney function damage, easy to cause hypoglycemia, unfavorable use. Gliquidone (gliquidon) is mainly metabolized in the liver, only approximately 5% excreted by the kidneys, renal insufficiency, relatively safe, and the use of large dose range, can be used as the preferred drug in patients with diabetic nephropathy. Some of the metabolites of glipizide are excreted by the kidney, but the activity is weak, so it is not easy to cause hypoglycemia reaction. The clinical stage of diabetic nephropathy proteinuria is biguanide oral hypoglycemic drug use, because it is in the prototype from the urine, easy to cause the accumulation of lactic acid and lactic acidosis. For patients with diabetic nephropathy who are not well controlled by diet and oral hypoglycemic agents, insulin should be used as soon as possible to delay and delay the occurrence and development of diabetic nephropathy. Needs to be emphasized is that of significant renal damage patients, should be considered to extend the half-life in blood insulin, followed by patients with loss of appetite, eating less, these are the need for insulin dosage of fine adjustment, regular blood glucose monitoring, avoid the occurrence of hypoglycemia. Attention should also be paid to improving insulin resistance and hyperinsulinemia. Diabetic patients are often due to inappropriate treatment due to insulin resistance and hyperinsulinemia, insulin can stimulate sustained arterial smooth muscle and endothelial cell proliferation; increased hepatic low density lipoprotein, promote pigmentation arterial wall lipid damage; endogenous fibrinolysis system such as stimulation of endothelial cells to produce plasminogen inhibitor, promote thrombosis; long-term hyperinsulinemia can increase blood pressure and weight gain can accelerate the occurrence and development of atherosclerosis. Reduce hyperinsulinemia in addition to the proper use of oral hypoglycemic agents, adding trace elements such as chromium alum and can increase insulin sensitivity. Rosiglitazone thiazine alkane two ketones hypoglycemic drugs found in recent years. The hypoglycemic effects include decreased plasma glucose and insulin levels, improve glucose tolerance; three lower plasma triglyceride and free fatty acid levels; reduce hepatic gluconeogenesis and uptake in adipose tissue and skeletal muscle stimulation of glucose. It is a better drug to improve insulin resistance. In addition, according to the results of recent studies, the role of non enzymatic glycation end products (AGE) in the development and progression of diabetic nephropathy, the use of AGE inhibitors in the treatment of diabetic nephropathy. Aminoguanidine: it is a AGE inhibitor, it can effectively prevent the formation of AGE or inhibit the activity of AGE in high glucose. Aminoguanidine selectively inhibits the formation of early glycation products of proteins by binding to glucose and binding of macromolecular proteins. According to the study, aminoguanidine can prevent NO activation, adjust the early diabetic vascular dysfunction. Inhibition of aldose reductase (spirohydantoin): clinical observation on preventing diabetic retinopathy, peripheral neuropathy and nephropathy is slight, and the slow onset. Due to the use of time is short, the use is not extensive, pending objective evaluation. 2 control of hypertension is a major factor in the occurrence and development of renal damage in patients with renal disease