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Diabetic Nephropathy

What is Diabetic Nephropathy?

What causes Diabetic Nephropathy?

Symptoms of Diabetic Nephropathy

How to diagnose Diabetic Nephropathy?

Clinical stages of Diabetic Nephropathy

Diet in Diabetic Nephropathy

Treatments for Diabetic Nephropathy

What is Diabetic Nephropathy?

Nephropathy is the deterioration of the kidneys. Diabetic Nephropathy is damage to your kidneys caused by Diabetes. The end-stage of Diabetic Nephropathy is called kidney failure, end-stage kidney disease, or ESRD.

According to surveys, Diabetes is currently the most common cause of ESRD, accounting for about 44 percent of all new cases of kidney failure in 2011. Both Type 1 and Type 2 Diabetes can lead to diabetic nephropathy, although Type 1 is more likely to lead to ESRD.

Diabetic Nephropathy develops through five clinical stages, of which the fifth is end-stage kidney failure. Early prevention, detection and treatment are essential for Diabetics to delay or control progression of Diabetic Nephropathy into the next stage.

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What causes Diabetic Nephropathy?

Each kidney is made of millions of thousands of small units called nephrons. These tiny structures filter your blood and help remove wastes out of the body.

For people with Diabetes, prolonged exposure to high blood glucose can impair those functioning kidney units and make kidneys to lose their filtering functions. In addition, hypertension, or high blood pressure, is a complication of Diabetes that is believed to likely contribute to occurrence of Diabetic kidney disease. Hypertension is believed to be both a cause of diabetic nephropathy, as well as a result created by the disease. As kidney disease progresses, physical changes in the kidneys can increase blood pressure.

Poorly controlled high blood pressure and high blood glucose make the progression to stage five kidney disease even more rapidly.

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Symptoms of Diabetic Nephropathy:

▲ Earliest manifestation-microalbuminuria (urine albumin excretion 30-300mg/24h).

▲ Increasing protein in urine.

▲ Edema in lower limbs, eyelids, ankles, face, etc.

▲Anemia

▲Poor appetite, nausea and vomiting

▲High blood pressure

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How to diagnose Diabetic Nephropathy? -----Exams and tests

Diabetic Nephropathy is diagnosed using tests that check for protein (albumin) in the urine, which points to kidney damage. Microalbumin urine tests can detect very small amount of proteins in urine which can not be detected by a routine urine test, allowing for early detection of Nephropathy. Early detection is very essential, to prevent further damage of the kidneys. The results of two tests, performed within three to six months, are needed to diagnose Nephropathy.

Diabetics have higher chances of kidney disease as their Diabetes course prolonging. It is suggested that Type 1 Diabetics should begin yearly microalbuminuria test after Diabetes for five years, and type 2 Diabetics need to start yearly test when they are diagnosed.

A microalbuminuria strip test can detect small amounts of proteins in the urine(microalbuminuria, also called as proteinuria). The strip changes color when there is protein in urine, thus providing an estimate for the output of proteins in urine. Spot urine test for microalbuminuria can precisely measure the exact amount of protein in urine.

In addition, serum creatinine test is frequently performed to diagnose kidney disease. Creatinine is a wasteful product that should be removed by the kidneys. The creatinine test is a blood test that shows how well the kidneys are working.

If your doctors suspect your kidney disease is caused by a disease other than Diabetes, other blood and urine tests may be performed.

Other tests for diagnosis of Diabetic Nephropathy

Regular blood pressure checkups both at home and at doctors' office are also important, because high blood pressure will rise as kidney damage deteriorates. Approximately two thirds of Diabetics have combined hypertension when their kidney disorder is diagnosed. Recommended blood pressure target for diabetics is 130/80mmHg. Keeping BP at targeted range can help diabetics prevent or slow damage to their kidneys.

Fungus examination is often adopted at the meantime, because retinal vascular damage often goes hand in hand with injury to renal capillaries. Blood cholesterols and triglycerides are also tested to see if diabetes, Nephrotic syndrome or other factors are elevating your blood cholesterols. High blood cholesterols can increase risks of hardening arteries (atherolsclerosis), possibly giving rise to heart disease, peripheral arterial neuropathy, stroke, etc.

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Stages of Diabetic Nephropathy

Diabetic Nephropathy is divided into five clinical stages:

Stage 1: starting stage of diabetic nephropathy. Glomerular filtration rate is higher than normal. Kidneys are enlarged obviously due to long-term of high filtration from Diabetes.

Stage 2: urine albumin excretion rate is within normal range in most cases, or may increase intermittently after exercise. There exist thickening of glomerular basilar membrane and mesangial proliferation from pathology. Glomerular filtration rate is still higher than normal and is in consistent with blood glucose reading.

Stage 3. Pre-clinical stage of diabetic nephropathy. Urine albumin excretion rate at 20-200ug/min, which is evidence for impaired glomerular filtrating structures and diagnosis of Diabetic Nephropathy. In many cases, blood pressure begins to increase at stage 3.

Stage 4 Diabetic Nephropathy-clinical proteinuria stage.

After Diabetes 15-25 years, 40% Diabetics will develop into this stage. Urine protein amount more than 0.5g/24h. GFR begins to decrease. Most patients develop edema in eyelids, limbs, ankles, etc due to fluid retention in their body.

Stage 5- end stage renal failure

GFR<15 patients have overall symptoms such as anemia, itchy skin, poor appetite, vomiting, headaches, weakness, etc. High creatinine and BUN levels. High blood pressure. Electrolyte imbalances, such as high phosphorus, hypernatronemia, low calcium, high phosphorus, etc. The patients may need to dialysis and kidney transplant to sustain their life.

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Diet for Diabetic Nephropathy

Restrict intake of sodium. Heavy sodium consumption will aggravate fluid accumulation in the body. In this way blood volume is increased and blood pressure is even higher. This is very harmful for the kidneys. Limiting sodium helps protect the kidneys and slow down kidney damage.

Balance intake of water. Fluid restriction should be performed carefully if one has severe swelling, obviously reduced urine output, or high blood pressure. In others, if there is no obvious kidney function reduction or fluid retention, there is no need to restrict your intake of water. Talk with your doctor to get individualized instructions.

Balances of energy supplements. Targeted goal of dietary energy supplement is meet basic daily body requirements and also stabilize the illness condition. Suggested daily total energy consumption in diabetes is 105-146kj/kg for diabetics, with carbohydrates accounting for 50-60% of total daily energy and proteins taking up for 20%。 Limit or get rid of rich cholesterol or fatty acid content products. High quality animal proteins are better choices than plant proteins because they will produce less urea and protect the kidneys.

Supplement sufficient vitamins. Supplying some vitamins such as folic acids is helpful for relieving renal anemia, improving nutrition status and resisting infections in the patients.

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What are the treatments for Diabetic Nephropathy?

Treatments for Diabetic Nephropathy include treatment in slowing down or controlling progression of kidney damage and treatment for repairing of the injured kidneys:

Lists of treatment for stabilizing kidney condition and remitting renal symptoms in Diabetic Nephropathy:

▲Control blood sugar. Medications, diet and physical activity can help control your blood sugar levels.

▲Control blood pressure. Medications, diet and physical activity can help control high blood pressure.

▲Avoid urinary tract infections and kidney infections. Avoid infections to not aggravate kidney damage.

▲ACE inhibitors. Those medicines help to reduce blood pressure, but also have shown to benefit kidney damage even if blood pressure is not high.

▲ Management of proteinuria. Medications can reduce the level of albumin and help slow or avoid further renal damage.

▲Treatment for renal anemia. You will be accessed for anemia ( a decreased number of red blood cells) and receive treatments if necessary.

▲The patients at end-stage kidney disease may require dialysis treatment to reduce accumulated wastes in their body so as to relive risks and complications.

Treatments for repairing the kidneys in Diabetic Nephropathy

First, Micro-Chinese Medicine Osmotherapy

Micro-Chinese Medicine Osmotherapy treats Diabetic Kidney Disease starting from removing initiating factors of renal fibrosis by Diabetes and creates a favorable environment for repairing injured renal intrinsic cells.

Healthy kidneys are responsible for filtrating bloodstream, carrying away wasteful products and stopping leakage of nutrients out of the body. In Diabetic Nephropathy, glomerular filtering cells are impaired thus causing loss of proteins and retention of wastes (such as urea and blood urea nitrogen). Micro-Chinese Medicine Osmotherapy removes blood stasis, stabilizes blood pressure and removes inflammations, which will stop renal fibrosis and transport sufficient nutrients and blood for fixing damaged glomerular cells. By the treatment kidney function is improved and symptoms can be got rid of effectively.

Second, Immunotherapy

Immunotherapy has distinctive effect in both treatment of Diabetes and diabetic kidney disease. Type 1 Diabetes is autoimmune destruction to pancreatic beta cells due to disordered immune system. Immunotherapy can regulate the immune system, increase immunity and stop auto destruction to insulin producing cells, which wills stablize blood sugar and slow down further damages to the kidneys.

Diabetic Nephropathy is thickening of glomerular basilar membrane due to high filtration pressure from Diabetes, deposition of sugar, protein, lipid or other product wasteful products. Immunotherapy treatment will apply advanced blood purification techniques to get rid of wasteful sugar metabolic end products, triglycerides, cholesterols, etc, thus stopping further kidney injuries. Immunotherapy and Micro-Chinese Medicine Osmotherapy are combined together for enhancement of kidney functions and avoid onset of advanced kidney disease or kidney failure.

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