How to reduce proteinuria in diabetic nephropathy

Written by Zhou Qi
Nephrology
Updated on September 18, 2024
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One major characteristic of patients with diabetic nephropathy is the increase in urine protein, and some patients may even have a large amount of urine protein. The treatment of this disease is indeed quite challenging, and there are not many effective treatments available clinically. In the early stages, when the patient's serum creatinine has not exceeded 256 µmol/L, clinicians often choose ACE inhibitors or angiotensin receptor blockers (ARBs) to reduce the pressure within the glomerulus and decrease urine protein. At the same time, it is recommended for patients to use insulin to control blood sugar. However, in recent years, there has been some progress in the treatment of diabetic nephropathy, such as the use of sodium-glucose cotransporter 2 inhibitors, which may help reduce urine protein. (Medication should be used under the guidance of a clinician, based on the specific condition of the patient.)

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Written by Zhou Qi
Nephrology
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Is diabetic nephropathy stage 3 reversible?

Patients with diabetic nephropathy actually have an irreversible condition. If a patient has developed mild to moderate proteinuria and entered stage three, it's generally because of long-term high blood sugar, oxidative stress, and an excess of glycation end products damaging the capillaries of the glomerulus, resulting in increased permeability and the occurrence of proteinuria. The damage that has already occurred cannot be reversed; however, patients still need active treatment to control their blood sugar and blood pressure in order to slow down the progression of diabetic nephropathy as much as possible. Stage three diabetic nephropathy is incurable, but treatment can slow the progression of the kidney disease, preventing the development from microalbuminuria to macroalbuminuria. Stage three refers to the early period of diabetic nephropathy, typically seen in diabetic patients who have had the disease for more than five years. It can feature a continuous increase in urinary albumin excretion rates. High filtration rates and long-term poor metabolic control may be reasons for the persistent microalbuminuria. During this stage, patients may experience a mild increase in blood pressure, and reducing blood pressure can decrease the excretion of microalbumin. During this period, strict control of blood sugar is necessary. Oral hypoglycemic drugs can be used for treatment, and it's crucial to regularly monitor fasting blood glucose, postprandial blood glucose, and glycated hemoglobin. Blood pressure should also be actively controlled, generally targeting a value of 130/80mmHg. Angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists are preferred as they can lower blood pressure, reduce proteinuria, and have a protective effect on the kidneys, thus delaying the progression of kidney disease.

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Written by Hu Lin
Nephrology
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How to prevent and treat diabetic nephropathy

The prevention and treatment of diabetic nephropathy include the following 6 aspects: The first is changing lifestyle, including controlling weight, diabetic diet, quitting smoking, quitting alcohol, and appropriate exercise. Changing lifestyle is the foundation of blood sugar control and a key to improving various metabolic disorders. The second is blood sugar control. Strict blood sugar control is the most important means to prevent the occurrence and development of diabetes and diabetic nephropathy. Under normal kidney function, it is recommended to keep glycated hemoglobin below 6.2%. For patients with abnormal kidney function or elderly patients, it can be relaxed to 7%. The third is to reduce blood pressure and proteinuria. The most commonly used medications are ACE inhibitors and angiotensin receptor blockers. Once diabetic microalbuminuria appears, blood pressure should be controlled below 130/80 mmHg. The fourth is to restrict the intake of dietary protein, with a focus on animal protein, i.e., high-quality protein. Early stage protein intake should be controlled at 0.8-1g/kg; for patients who have developed renal failure, controlling protein intake at 0.6-0.8g/kg is more appropriate. The fifth involves controlling other factors, including a low-salt diet and treating hyperlipidemia. The sixth is the treatment of end-stage diabetic nephropathy. Since diabetic nephropathy patients frequently have cardiovascular complications and symptoms of uremia appear earlier, it is appropriate to start dialysis treatment early. (Please take medications under the guidance of a doctor.)

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Written by Zhou Qi
Nephrology
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Is diabetic nephropathy with facial swelling serious?

Patients with diabetic nephropathy who experience facial swelling should not use this symptom as a basis for judging the severity of their condition. Diabetic nephropathy is divided into five stages. The condition is relatively mild during the first three stages. By the fourth stage, patients begin to exhibit significant proteinuria, and by the fifth stage, they experience severe renal failure. Conditions in these last two stages are quite severe. However, patients might also experience facial swelling during the first three stages, and while the likelihood of facial swelling increases during the fourth and fifth stages, some patients in these stages might not show obvious edema. Therefore, it is difficult to determine the severity of the condition based solely on swelling. Patients need to undergo 24-hour urinary protein quantification and blood tests to assess kidney function in order to judge the severity of their condition.

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Written by Zhou Qi
Nephrology
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Symptoms of diabetic nephropathy anemia

Patients with diabetic nephropathy who exhibit anemia indicate that they are experiencing relatively severe renal failure. Such patients may show clear clinical symptoms, such as significant edema, excessive proteinuria, and renal failure. The impaired water excretion can lead to swelling in the lower limbs and facial area. The presence of anemia causes fatigue in patients, potentially leading to chronic ischemia and hypoxia in some organs. Symptoms such as listlessness and drowsiness may occur. In the state of anemia due to diabetic nephropathy, the accumulation of metabolic waste may also affect the patient's appetite, causing poor food intake. Additionally, diabetic damage to the retinal arteries can lead to a decline in vision, or even complete blindness.

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Written by Zhou Qi
Nephrology
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How many years can a person with diabetic nephropathy live?

Diabetic nephropathy is divided into several stages, from mild to severe. In the early stage, patients only have an increased glomerular filtration rate and the proteinuria is not significant. As the disease progresses, the protein in the urine increases, eventually leading to renal failure and even developing into uremia. The entire process can last many years, with some patients experiencing it for up to ten years. In fact, when diabetic nephropathy progresses to its final stage, uremia, patients still have many treatment options, such as hemodialysis, peritoneal dialysis, or kidney transplantation, and even combined kidney and pancreas transplantation. Therefore, how long a patient can live depends on the patient's age, presence of cardiovascular and cerebrovascular diseases, and the choice of treatment methods, among other factors.