How to Slow Down the Progression of Diabetic Nephropathy
The treatment of Diabetic Nephropathy is mainly to control blood sugar, manage blood pressure and reduce urine protein. It also includes lifestyle intervention, correction of lipid metabolism disorder, treatment of complications of renal insufficiency, dialysis treatment and so on.
(1) Lifestyle change
The patient should pay attention to the combination of work and rest, give up smoking and alcohol. They can take part in proper physical exercises to enhance their physique and prevent infection. In patients with obvious edema, high blood pressure or renal insufficiency, appropriate rest, regular follow-up and detection of weight, blood pressure and creatinine should be emphasized.
The diet emphasizes reasonable dietary structure, ensure reasonable and adequate intake of nutrition, maintain healthy and normal weight, and reduce the burden of islets. A low amount of high quality protein, low salt, low fat, high calcium and low phosphorus diet should be given priority to, and sugar intake should be controlled.
(2) Strict control of blood sugar
Actively control blood sugar, including dietary therapy, oral hypoglycemic drugs and insulin. The target of blood sugar control is glycosylated hemoglobin (HbA1c) no more than 7%. For elderly patients, HbA1c control target should be controlled to no more than 7% - 9%. The dosage and type of insulin and oral hypoglycemic drugs should be adjusted in time according to renal function and blood sugar
(3) Active control of blood pressure
Hypertension is not only common in diabetic nephropathy, but also an important factor in the occurrence and development of diabetic nephropathy. In the early stage of Diabetes mellitus, intensive blood pressure control can not only significantly reduce the risk of diabetic macroangiopathy, but also significantly reduce the risk of microangiopathy. Blood pressure control objectives: The target of blood pressure control for diabetic patients is 140/90 mmHg, and 130/80 mmHg for young patients or patients with nephropathy. ACEI (captopril, benazepril, etc.) or ARB (valsartan, irbesartan, etc.) are the preferred antihypertensive drugs.
(4) Reasonable control of blood lipids
Diabetic patients often have disorders of lipid metabolism, which can induce cardiovascular disease and aggravate renal damage. Therefore, active treatment is also needed. Treatment includes diet therapy and drug therapy. Oral statins (Lipitor, etc.) are preferred as lipid-lowering drugs, and Beta-type lipid-lowering drugs are preferred when triglycerides (TG) are elevated. In order to improve drug compliance, we should eat less food rich in cholesterol and saturated fatty acids, such as egg yolk, fat meat, animal viscera and so on.
(5) Restriction of water intake
Diabetic nephropathy patients should accurately record 24-hour water consumption and urine volume. Water intake should be controlled at 500 ml plus urine volume on the previous day. And pay attention to observe urine volume, color, character changes, and edema changes. When there are obvious abnormalities, receive timely medical treatment.
(6) Treatment of reducing urinary protein
ACEI or ARB and active vitamin D3 are recommended for diabetic patients with normal blood pressure and urinary protein level (>= 30 mg/g). For patients with massive proteinuria, Tripterygium wilfordii can be given hypoproteinuria treatment. Current studies have shown that tacrolimus can treat some early diabetic nephropathy, reduce proteinuria and improve clinical symptoms such as edema.
(7) Renal replacement treatment
Once renal insufficiency occurs, treatment such as blood sugar reduction, blood pressure reduction, kidney preservation and swelling elimination should be given to delay the progress of kidney disease. Renal replacement therapy, including hemodialysis, peritoneal Dialysis and kidney transplantation, can be done.
Most of the patients have no specific manifestations in the early stage, so they are easily neglected. Once there are any abnormalities, the kidney has been significantly damaged. 24-hour urinary microalbumin or nephrotic index is a sensitive index of early nephropathy, which is very important for early detection and intervention of nephropathy. Patients without nephropathy should be followed up at least 1-2 times every six months to one year. Patients with high risk factors of nephropathy, such as hypertension, hyperlipidemia, hyperglycemia, long course of disease and other microangiopathy, should increase the frequency of monitoring and visit regularly. For more information on Diabetic Nephropathy treatment, please leave a message below or contact online doctor.
***Please seek professional medical advise for the diagnosis or treatment of any ailment, disease or medical condition. This article is not intended to be a substitute for the advice of a licensed medical professional.***