Diabetic nephropathy Standard health care and Integrated health care2017-04-26 15:22
First, the standard health care (national application based on evidence-based medicine, with a good medical security system and good effect of the price of health care)
1. Patients need to be tested annually for urine protein in morning urine (or random urine). If the paper method is positive: Check whether urinary protein / creatinine ratio (PCR) is determined if there is no urinary tract infection. If the paper is negative, Urinary albumin: Urine albumin / creatinine ratio (ACR) can be measured; if ACR can not be measured, semi-quantitative method can be used.
2. If PCR or ACR increased: (male microalbuminuria ACR> 2.5 mg / mmol, female> 3.5 mg / mmol or 30 mg / g), repeated 2 times in the following 4 months. If proteinuria or urinary albumin is increased twice in 3 test results, it is determined to be positive. If repeated twice are not increased, then check once a year.
3. In the case of increased urinary albumin or decreased proteinuria and eGFR (<90 ml / min / 1.73 m2 or continued to decrease), the following treatments were performed: ACE inhibitors or angiotensin II receptor antagonists were used to the maximum tolerated dose , Application of drugs and diet regulation (low salt) to strengthen the treatment of hypertension (target <130/80 mmHg). Strict control of blood sugar (target Hb A1c <6.5). The progression of renal damage was monitored by measuring ACR or PCR, serum creatinine, and serum potassium; eGFR was measured and the results were evaluated. If there is proteinuria, it is recommended to limit protein intake at 0.8 g / kg / d; strengthen the application of other methods to protect the kidneys and cardiovascular (smoking, the use of Aspirin, lipid-lowering therapy)
4. If the patient's eGFR <90 ml / min / 1.73m2, you need to measure hemoglobin / ferritin every 6 months and give iron or other blood drugs. If the patient is supplemented with the above preparations, still anemia (premenopausal women Hb <11 g / dl, other people <12 g / d1), you need to turn the kidney specialist by the specialist treatment.
5. When the eGFR <60ml / min / 1.73 rn2 will be patients with kidney specialist treatment. When the patient has kidney disease symptoms or biochemical abnormalities or sodium and sodium retention occurs, you should recommend early patients with kidney specialist treatment.
Second, comprehensive health care (including the provision of DM patients with the latest health care technology to achieve the best results.)
1. In general, it is the same as standard health care. But the urinary albumin determination is always applied quantitative method (ACR).
2. Patients need to undergo autoantibodies, ultrasound, renal biopsy, etc. to exclude other renal diseases that may lead to increased ACR or PCR.