Diabetes mellitus provokes a number of negative changes in the body, affecting almost all organs and causing their dysfunction. So, one of the most common secondary diseases, developing both in insulin-dependent patients, and in insulin-dependent ones, is diabetic nephropathy, in which the kidneys are a pathological target.
Diabetic nephropathy - classification by stages
This complication of diabetes is associated with a violation of the metabolism of carbohydrates and lipids in the kidney tissues, resulting in the defeat of the arteries, arterioles, capillary glands and tubules of the organ. Gradually, impaired renal function in the absence of treatment leads to a complete cessation of their work and becomes a threat to life.
In world practice, the division of this complication into five periods, developed by Mogensen, is used. Let us consider in more detail which stages of diabetic nephropathy are divided, their main characteristics:
- The first stage is the hyperfunction of the organ. It occurs in the debut period of diabetes and is characterized by an increase in the size of the blood vessels of the kidneys and activation of blood flow in them, increased excretion and filtration of urine. The body itself is somewhat enlarged, while the protein in the urine is not yet detected.
- The second stage is the initial structural changes in the organ. It develops around the third year from the onset of diabetes. At this stage, the pathology of the wall of the kidney vessels continues to thicken, hyperfiltration of glomeruli, expansion of the intercellular space is observed. The protein is not found.
- The third stage is the beginning nephropathy. The report of this stage begins approximately from the fifth to the seventh year after diagnosis of diabetes. Due to the constant elevated pressure in the damaged kidney vessels, a slight increase in the rate of filtration of water and low molecular weight compounds through the renal filter occurs. The allocation of an inessential amount of protein with urine begins.
- The fourth stage is the period of pronounced diabetic nephropathy. It is defined in patients with diabetes mellitus with "experience" of more than 10-15 years. At this stage, a huge amount of protein is continually excreted in the urine, in the body regulating mechanisms are included to maintain its desired level. There is a slowing of blood flow in the kidneys and the rate of glomerular filtration, there is an irreversible hypertrophy of the glomeruli.
- The fifth stage is uremic. Virtually all vessels are sclerotized, unable to perform excretory function. In the final stage of the disease, due to renal failure, tissue intoxication is produced by protein metabolism, massive proteinuria, anemia and many other pathological processes are observed.
Diabetic Nephropathy - Symptoms
Diabetic nephropathy, the causes and mechanisms of development of which remain unclear, is asymptomatic for a long time. So, in the 1-3 stages, called preclinical, without special studies, it is impossible to reveal the defeat of the kidneys. The first "bell" often appears periodically arising increase of arterial pressure . Other signs of diabetic nephropathy, which develop as the pathology progresses:
- swelling;
- strong weakness;
- decrease in body weight;
- headache;
- thirst;
- nausea;
- ammonia odor from the mouth;
- dyspnea;
- heartache;
- dry skin;
- itching;
- impaired vision, etc.
Diabetic Nephropathy - Diagnosis
Due to the fact that general laboratory analyzes are not able to provide information on preclinical stages of pathology, diabetic nephropathy should be detected in patients with diabetes by special methods (they should be performed in patients once a year). Thus, it is possible to diagnose the complication by such two laboratory tests:
- quantitative determination of albumin (protein) in urine;
- determination (calculation) of the glomerular filtration rate taking into account the concentration of blood creatinine.
In addition, diabetic nephropathy of the kidney is diagnosed with the help of such studies:
- general analysis of blood and urine;
- blood chemistry;
- Doppler ultrasound of the kidneys;
- organ biopsy.
Diabetic Nephropathy - Treatment
The most important condition for effective treatment for this complication is an adequate effect on the root cause - an elevated level of glucose in the blood. Another essential requirement is the normalization of blood pressure and lipid metabolism. Due to the control of these indicators, the prevention of diabetic nephropathy and the suspension of the rate of its progression are carried out.
In case of timely detection of nephropathy in diabetes mellitus is treated successfully, and much depends on the patient himself. Observance of the following conditions increases the chances of a positive result:
- increased physical activity;
- refusal from alcohol and smoking;
- reduction of mental stress;
- diet.
Diabetic nephropathy - treatment, drugs
Drug therapy is performed taking into account the stage of complication, the presence of other pathological changes in the body. The list of basic drugs includes:
- hypoglycemic agents or insulin (if diabetic nephropathy is diagnosed, type 2 diabetes mellitus is often transferred to insulin therapy);
- inhibitors of the angiotensin-converting enzyme;
- calcium antagonists;
- selective beta-blockers;
- lipidemic preparations;
- diuretics;
- preparations of iron and calcium;
- enterosorbents, etc.
Hemodialysis with diabetic nephropathy
When swelling becomes large and uncontrolled with diabetic nephropathy, there are signs of severe intoxication, vision is impaired, which indicates a severe complication stage and is confirmed by analysis, hemodialysis can not be avoided. This method involves the purification of blood by means of special apparatus. Often, severe diabetic nephropathy requires surgery for a kidney transplant.
Diabetic nephropathy - treatment with folk remedies
At preclinical stages, diabetic nephropathy can be treated additionally by alternative methods, but this should be discussed with the doctor. It is established that the course of diseases such as diabetes mellitus, nephropathy, hypertension is facilitated by the intake of decoctions of medicinal plants. Such phytopreparations include:
- Bay leaf;
- sage;
- chamomile;
- mint;
- succession;
- yarrow;
- oats, etc.
Diet with diabetic nephropathy
Proper nutrition is one of the bases of successful treatment of this complication. The diet for diabetic nephropathy of the kidneys, the list of foods in which is limited to low-protein and low-salinity dishes, should be high in calories. Allowed:
- vegetables fruits;
- milk porridge;
- saltless bread;
- dairy products;
- olive oil;
- low-fat meat, etc.
Prohibited:
- Smoked meat, fatty dishes;
- marinades;
- cheeses;
- beans;
- mushrooms;
- chocolate;
- caviar, etc.