Early prevention and treatment of diabetic nephropathy2017-04-26 18:28
The main goal of DN prevention and control is to prevent the occurrence and development of DN, prevention is very important. At the time of microalbuminuria, we have about 30% chance to reverse, so it is very important for us to seek the support of the doctor. Now there is no effective method for treatment of DN, and the main method is to control the risk factors of disease progression. Including the following aspects:
The improvement of life style
Cigarette smoking is an independent risk factor for the development of type 2 diabetes mellitus to DN, and it is associated with deterioration of renal function. Quitting smoking can reduce the risk of DN progression by 30%. Therefore, it is recommended that all patients with diabetes should quit smoking. Weight control is also an important measure. Studies have found that overweight patients with a decline in body weight index, can achieve stable renal function, significantly reduce the role of proteinuria. DN patients were recommended to control body weight at 18.5 to 24.9[body weight index = body weight (kg) / height (M2)].
2 diet therapy
Low protein diet can reduce urinary protein excretion in DN patients and delay the deterioration of renal function. In early DN, protein intake should be controlled in the normal low limit [0.8-1.0g/ (kg * d)]; when renal dysfunction protein intake should be controlled at 0.6 - 0.8g/ (kg * D), and based on animal protein. In order to avoid the occurrence of malnutrition, patients with low protein diet should ensure adequate calorie intake. Patients with conditions can add with alpha keto acid preparation. In addition, DN patients should also be appropriate to reduce the salt in the diet, eat less high purine foods, such as animal offal, seafood, beer, etc..
3 control blood sugar
Hyperglycemia is the initiating factor causing DN. Intensive glucose control can delay the occurrence of microalbuminuria in patients with type 1 and type 2 diabetes, and delay the progression of microalbuminuria to clinical proteinuria. The choice of drugs does not emphasize the need of insulin. The choice of hypoglycemic drugs should be based on the complications of patients, age and other factors to consider the choice of the type and dose of drugs and strengthen the target value of blood glucose control. In order to prevent the occurrence of microalbuminuria, as far as possible, it is suggested that the blood glucose control should be strengthened as soon as possible, so that HbA1c is less than 7% .
4 blood pressure control
Hypertension plays a key role in the progression of renal failure. It is also important to strictly control blood pressure and to control blood sugar strictly to delay the development of diabetic complications. Patients with DN should be recommended to control blood pressure below 130 / 80mmHg, lower than those without diabetes. In the aspect of the selection of antihypertensive drugs, angiotensin converting enzyme (ACEI) inhibitors or angiotensin II receptor antagonist (ARB) should be the first choice, when necessary, combinating of two to more antihypertensive drugs(including calcium channel blockers, diuretics, the 3 generation B receptor blocker), attention to the monitoring of renal function and serum potassium changes.
5 lipid-lowering therapy
Patients with diabetes often associated with lipid metabolic disorders, hyperlipidemia can also accelerate the decline of renal function and mortality of dn. Through reasonable diet, weight loss, blood sugar control, can improve hyperlipidemia. When the blood glucose control and diet treatment can not achieve the goal, can be given lipid-lowering drug treatment. Patients mainly with the increase of triglyceride choose the Fibrates drugs, and cholesterol was increased to choose other statins drugs. The standard of treatment is as follows: total cholesterol <4.5mmol/l, low density lipoprotein cholesterol (LDL-C) <2.6mmol/l, high density lipoprotein cholesterol (HDL-C) >1.1mmol/l, triglyceride (TG) <1.5mmol/l.
6 control proteinuria
Proteinuria is not only the clinical manifestation of DN, but also an important risk factor for the deterioration of renal function and the increase of cardiovascular events. Patients with normal blood pressure should also be treated with ACEI or ARB to reduce urinary albumin excretion.
7 measures to reduce vascular disease
The use of antiplatelet drugs (such as aspirin, dipyridamole) or blood circulation of traditional Chinese medicine can delay the progress of some patients with DN disease.
In summary, the key of early diabetic nephropathy, lies in comprehensive prevention and treatment. The general population should strengthen their own health concerns, regular physical examination, as long as found problems, do a timely treatment to the Department of nephropathy clinic and strictly follow the doctor's advice, make sure the disease is nipped in the bud.