Friday, August 3, 2012

Treatment principle for diabetic nephropathy


Diabetic patients with proteinuria, 24h urinary albumin> 300mg, can be considered to exist diabetic nephropathy. Due to diabetic nephropathy insidious onset and progressive deterioration, kidney damage, the lesion is irreversible, until renal failure. Therefore, the prevention and treatment of diabetic nephropathy is particularly important, their treatment of the following principles:


(1) low-protein diet low protein diet can reduce glomerular perfusion, reduce proteinuria, lower diastolic blood pressure, and serum albumin concentration, creatinine clearance and stability. Currently recommended protein intake for a day 0.6g/kg daily protein intake of total calories, less than 20% is appropriate.


(2) early control of blood glucose of diabetic nephropathy, strict control of blood sugar, reduce proteinuria, improve glomerular filtration rate, thereby inhibiting renal hypertrophy. Insulin promotes the use of intensive therapy, enable the glomerular filtration rate and urinary microalbumin more than normal, improving renal function. Diabetic nephropathy in the late strict glycemic control, there are still certain benefits, help to reduce the incidence of urinary tract infections, and to prevent urinary tract infections further damage the kidneys.


(3) control of blood pressure and diabetic nephropathy with hypertension, multiple high-capacity, low renin, it will control the blood pressure at normal levels, is an important part of slow diabetic nephropathy deterioration of renal function. Clinical practice has proved effective to stabilize the blood pressure, can significantly reduce proteinuria, and renal function decline and deterioration of vision. That angiotensin-converting enzyme inhibitors such as captopril (captopril), benazepril (benazepril), suppression Ping Shu, diabetic nephropathy with hypertension is the most appropriate preparations. Such agents through the expansion of small arteries and reduce glomerular pressure, reduce proteinuria and stable renal function. Calcium antagonists such as nifedipine (nifedipine) and amlodipine (Norvasc), can also be used to control hypertension of diabetic nephropathy.


(4) application of anti-platelet and microcirculation drug compound aspirin, dipyridamole, tetramethylpyrazine, Salvia preparations with a stable renal function and reduce proteinuria role. Prostaglandin synthesis agent, B pentoxifylline, etc., reduce micro-albuminuria, increased the role of the creatinine clearance rate.


(5) should be used right kidney non-toxic or low toxic drugs in patients with diabetic nephropathy, the use of hypoglycemic agents, antihypertensive drugs and antibiotics, should select an effective and kidneys of non-toxic or low toxicity drugs. Appropriate level such as hypoglycemic New Drug sugar, only 5% by renal excretion, it is suitable for patients with diabetic nephropathy; antihypertensive drugs captopril, enalapril, etc., not only the systemic antihypertensive effect, but also reduce glomerular pressure, can reduce urinary protein excretion without compromising renal blood flow, is one of the current drug of choice in the treatment of diabetic nephropathy.


(6) late renal transplant patients with diabetic nephropathy should be preferred renal transplantation treatment. Cadaveric renal transplantation and living related kidney transplantation a high success rate, there are indications can choose the right time.

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