Friday, September 6, 2013
Treatment of Diabetic Nephropathy
The main diagnostic base of clinical diabetic nephropathy is proteinuria. If the factors, such as urinary infection, diabetic ketoacidosis, heart failure, glomerulonephritis, can be excluded, it’s more likely to be diabetic nephropathy.
DN still has no effective therapy. The treatment principles are:1. To strictly control blood sugar to make the blood sugar close to the normal level, and prevent and delay the occurrence of DN; 2. to delay the rate of kidney function decrease;3.to treat with dialysis or kidney transplant.
1. To strictly control glucose. Before occurring to clinical DN, use insulin pump or multiple subcutaneous insulin injection to control Diabetic Mellitus and keep the glucose the normal level, which can delay even prevent the occurrence and development of DN. It is good for other complications to lower the increasing GFR and improve microalbuminuria. According to The Diabetes Control and Complications Trial(DCCT) study, T1DM treated with insulin intensive treatment can reduce by 35%-55% of the occurrence rate for DN. Controlling glucose for the patients having developed into clinical DN and having obvious proteinuria is less useful for disease development. Hypoglycemic drugs will change into insulin after occurring to Clincial DN.
2. To control hypertension. Hypertension can accelerate the development of Renal Failure. The effective hypotensive treatment can slower the speed of GFR reduction and decrease the output of urinary albumin. Angiotensin coverting enzyme inhibitor or angiotensin Ⅱ receptor antagonist can be the first choice, and often used together with other hypotensive drugs, such as calcium antagonists, diuresis, β adrenergic receptor, methyldopa, and clonidine. If patients’ pressure is more than ≥130//80mmHg
3. Limit in protein intake. Proper reducing protein intake in food can decrease the intraglomerular pressure, high filtration and proteinuria. In contrast, high protein food may aggravate glomerular histological lesion. Patient with renal insufficiency should strictly control protein intake and take high quality protein containing essential amino-acid.
4. Dialysis and kidney transplantation。 Once patients progress to renal failure, the only effective ways are dialysis and kidney transplantation. Kidney transplantation is the best treatment for diabetic nephropathy, prior to dialysis. But for the patients over age of 65, the after-transplantation effect is poor.
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