How to check for diabetic nephropathy?

Written by Zhou Qi
Nephrology
Updated on September 21, 2024
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For the examination of diabetic nephropathy, patients first need to undergo routine urinalysis and check for the urinary albumin excretion rate. Generally speaking, one characteristic of diabetic nephropathy is the presence of urinary protein. A urinary albumin excretion rate between 20 and 200 µg/min is an important basis for diagnosing early diabetic nephropathy. If a patient’s urinary albumin excretion rate consistently exceeds 200 µg/min, significant diabetic nephropathy is often considered. Of course, this is under the assumption that the patient has had diabetes for at least ten years and has diabetic retinopathy. A kidney biopsy is needed for confirmation. Of course, to assess the impact of diabetic nephropathy on kidney function, blood tests for serum creatinine and urea nitrogen are necessary.

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Written by Hu Lin
Nephrology
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What are the symptoms of diabetic nephropathy?

The symptoms of diabetic nephropathy mainly include the following aspects: The first one is proteinuria, where patients may notice an increase in foam in their urine, and upon examination, proteinuria will test positive. The second symptom is edema, which may initially appear as intermittent swelling but gradually develops into swelling of both lower extremities or even the entire body. Of course, pleural effusion and ascites may also occur. The third type of symptom is hypertension; diabetic nephropathy combined with hypertension often involves stubborn high blood pressure, which requires multiple antihypertensive drugs to control. The fourth point is that in the later stages of diabetes, signs of renal failure gradually appear, such as nausea, vomiting, difficulty breathing, anemia, renal osteopathy, skin itching, and more. The fifth is extrarenal manifestations, such as diabetic retinopathy presenting with vision loss or even blindness, and diabetic neuropathy leading to numbness and abnormal sensations in the hands and feet. Additionally, it is common for patients with diabetic nephropathy to also experience cardiovascular and cerebrovascular complications, such as coronary heart disease, myocardial infarction, stroke, and more.

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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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Nephrology
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Does diabetic nephropathy cause back pain?

Diabetic nephropathy generally does not cause symptoms of back pain. Diabetic nephropathy refers to patients with long-term hyperglycemia, typically those whose blood sugar has been elevated for ten years or more, causing damage to the small blood vessels. The kidneys, being rich in small blood vessels, undergo glomerular sclerosis. Early in the disease, patients experience an increased glomerular filtration rate. As the condition progresses, proteinuria gradually increases. When proteinuria occurs, patients may exhibit noticeable edema, and in some cases, patients may develop severe edema due to substantial proteinuria, leading to serious complications like pulmonary edema and heart failure, which manifest as respiratory difficulties and chest tightness. However, these conditions do not cause back pain, even though there is glomerular sclerosis, as patients do not feel any pain associated with it.

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How to supplement for anemia in diabetic nephropathy?

Patients with diabetic nephropathy who exhibit anemia are often in a state of chronic renal failure. This anemia caused by chronic kidney disease is mainly due to the decreased secretion of erythropoietin by the kidneys. Therefore, treatment involves the use of erythropoietin to stimulate bone marrow hematopoiesis. In addition to this medication, patients generally also need to supplement with iron preparations, such as ferrous succinate, sucrose iron, etc., and take oral folic acid, all of which are raw materials for blood formation. Furthermore, if patients have severe malnutrition, they should also supplement with foods rich in protein, such as eggs, milk, chicken, duck, fish, etc. (Please use medications under the guidance of a doctor.)

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Written by Zhou Qi
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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.