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Early screening of diabetic nephropathy

2017-07-26 10:36

Diabetic nephropathy is the most important single factor in the etiology of chronic renal failure in adults. Diabetic nephropathy can occur in type 1 diabetes and type 2 diabetes, and the incidence of diabetic nephropathy in T1DM patients is higher, 30%-40%. Diabetic nephropathy occurs in about 34.7% of T2DM patients. Therefore, early detection of diabetic nephropathy is very important. Diabetic nephropathy can be divided into the following five phases:

Stage I: glomerular filtration rate increased, kidney volume increased, renal blood flow, glomerular capillary perfusion pressure and internal pressure increased. The glomerular basement membrane and the mesentery are normal. After proper treatment, it can be recovered.

Stage II: normal albuminuria. The glomerular filtration rate is normal or higher, the excretion rate of urine albumin is normal, and the excretion is increased after exercise or stress, and then returned to normal after removing the cause. The glomerular basement membrane is thickened and the mesangial matrix is increased. Blood pressure get normal.

Stage III: early diabetic nephropathy. Glomerular filtration rate was approximately normal, urinary albumin excretion rate was higher than normal, and blood pressure was slightly elevated. Glomerular basement membrane thickening and mesangial matrix increased significantly. There were glomerular nodular and diffuse lesions and arteriole hyaline degeneration, and glomerular degeneration had begun to occur. This period of blood pressure in patients with mild elevation, lower blood pressure can partially reduce the excretion of urinary albumin.

Stage IV: clinical diabetic nephropathy. A lot of albumin, urine protein was consistently greater than 0.5 grams for every 24 hours of non selective proteinuria, severe proteinuria more than 24 hours per 3.5 grams, appeared hypoalbuminemia, edema and hypertension, often with varying degrees of nitrogen retention and diabetic retinopathy. The glomerular basement membrane is thickened, the mesangial matrix is increased, and the glomerulus becomes obsolete.

Stage V: end-stage renal failure. Urinary protein excretion due to reduced glomerular obsolescence, glomerular filtration rate 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 this five stages, stage three is the most critical stage: early diabetic nephropathy, which is the first discovery of diabetic nephropathy stage, so when the effective intervention will be further developed to prevent diabetic nephropathy has obvious effect. Diabetic nephropathy at the beginning of the disease often does not have obvious symptoms, until the patient found, usually in the middle or late stage of kidney disease, treatment difficulties, pain to patients. Therefore, we have to each of the first onset of type 2 diabetes and type 1 diabetes mellitus patients over 5 years of urine microalbumin screening, in order to early diagnosis, early treatment, early benefit.

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