From diabetes to uremia, there are only three steps

If diabetes is left unchecked, kidney complications can occur within 10 years; If blood sugar and blood pressure are not effectively controlled at this time, uremia will develop in a few years
.

From diabetes to uremia, there are often only three steps

The first step is urine protein

In the second step, serum creatinine rises

Step three, uremia

According to statistics, about 1/3 of diabetic patients will develop kidney complications
.
The process from diabetes to uremia is roughly the following path
.

1.
Proteinuria

Hyperglycemia can cause glomerular hyperfiltration, hyperperfusion, high pressure, increase the burden on the kidneys, and over time, the kidneys are overwhelmed, the glomerular filtration membrane will be damaged, and the protein in the blood leaks into the urine to form urine protein
.

2.
Elevated serum creatinine

Serum creatinine is the most important measure of kidney function, and an increase in serum creatinine means a decrease
in kidney function.
In the early stage of diabetes, due to the filtering effect of high sugar, the glomeruli are in a state of hyperfiltration and the serum creatinine is slightly low
.
However, under long-term high filtration pressure, the glomeruli will gradually be damaged
.
There are about 200~2.
4 million glomeruli in both kidneys, and when more than half of the glomerular sclerosis and necrosis, blood creatinine begins to rise
.
That is, when the serum creatinine is elevated, more than half of the glomeruli in both kidneys
have been destroyed.

3.
Uremia

If the serum creatinine continues to rise more than 707mmol/L, or the glomerular filtration rate < 15ml/min, it enters the terminal stage, that is, end-stage renal disease or chronic kidney disease stage 5, commonly known as uremia<b10>.
At this stage, kidney function has been unable to meet the body's metabolic needs, metabolic waste accumulation, in addition to blood creatinine, urea nitrogen, blood uric acid increased, there will also be metabolic acidosis, hyperkalemia, hyperphosphatemia and other complications
.

The ability of the kidneys to regulate water and blood pressure is also greatly reduced, blood pressure will be further increased, and even malignant hypertension will appear, and some patients will also have edema
.

The kidneys cannot secrete enough erythropoietin to promote erythropoiesis, and renal anemia occurs; Failure to activate vitamin D can lead to complications
such as calcium and phosphorus metabolism disorders, osteoporosis, and metastatic calcification.

In addition, due to long-term hypertension after kidney disease, as well as complications such as water and sodium retention, renal anemia, and metastatic calcification, it will eventually damage the heart and cause coronary heart disease, heart failure, cerebrovascular disease, etc
.

From diabetes to uremia, although it is a simple three steps, it is actually a long process, and any step in the meantime, if it is controlled in time, will avoid the occurrence
of uremia.

Early detection

The Chinese Guidelines for the Prevention and Treatment of Diabetic Kidney Disease (2021 Edition) recommend:

Patients with type 1 diabetes mellitus and type 2 diabetes mellitus who have been ill for more than 5 years should have urine albumin/creatinine and estimated glomerular filtration rate tested at the time of diagnosis, and should be screened at least once a year thereafter
.

Urine albumin/creatinine ratio (ACR) refers to the ratio of urine microprotein to urine creatinine, which can be used to detect urine microalbumin concentration, which is a simple, fast and accurate indicator
of urinary microalbumin excretion.
The normal value is 0~30mg/L
.

Early detection of microalbuminuria, especially in the stage of intermittent microalbuminuria, after active control of blood sugar, blood pressure, blood lipids and other risk factors, some patients can return to normal proteinuria, once missed this optimal treatment period, the disease progresses to the stage of clinical diabetic nephropathy, it is difficult to completely reverse
.

Early intervention

1.
Exercise

On the one hand, long-term, regular and moderate exercise can reduce weight, control blood sugar and blood pressure, improve lipid metabolism, improve quality of life, and help the prevention and treatment of diabetic nephropathy; On the other hand, regular exercise training can improve cardiorespiratory endurance, muscle strength and health-related quality of life in patients with diabetic nephropathy, reduce the inflammatory state of the body, reduce the risk of cardiovascular disease, and delay renal impairment
.
Therefore, exercise is particularly important for patients with diabetic nephropathy, and it is recommended that patients carry out reasonable, regular and moderate physical exercise
according to their own conditions.

Patients with diabetic nephropathy should be evaluated
for exercise rehabilitation before exercise.
Types of exercise include aerobic exercise, resistance exercise, and flexibility training
.
Common aerobic exercises include walking, jogging, cycling, swimming, fitness dancing, etc
.
Common resistance exercises include sit-ups, push-ups, dumbbells, stretching pullers, etc
.
Flexibility training (e.
g.
, tai chi, square dance) is carried out in the preparation and end stages of exercise training, mostly combined
with aerobic exercise training.
The target time of each exercise is 30~60 min, which can be adjusted
according to the individual condition of diabetic patients.

In terms of exercise intensity, moderate aerobic and resistance exercise
is recommended for patients with diabetic nephropathy.
The frequency of exercise is recommended that patients need to exercise at
least 3 times a week on the basis of increasing daily physical activity.

Patients with diabetic nephropathy should stop exercising in time and seek medical attention if the following conditions occur:

➤ Severe chest tightness, shortness of breath, difficulty talking;

➤ Headache, dizziness, darkness, weakness;

➤ Severe arrhythmias;

➤Burning pain, soreness, narrowing sensation in chest, arms, neck or jaw;

➤Exercise-related muscle spasms, soreness, joint pain, darkening of urine, etc
.

2.
Weight loss and smoking cessation

Studies have shown that weight loss (calorie restriction, increased exercise, etc.
) can be used as an adjunct to reduce obesity or overweight in people with diabetic nephropathy
.
Smoking is a risk factor for the progression of kidney function in patients with diabetic nephropathy, and reducing smoking or quitting smoking is an important measure
to prevent or control the progression of diabetic nephropathy in diabetic patients.
The results showed that the greater the number of cigarettes smoked in diabetic patients, the higher the prevalence of diabetic nephropathy, and quitting smoking reduced the glomerular filtration rate and urinary albumin levels
in diabetic nephropathy.

3.
Protein intake

Protein restriction is an important treatment for patients with diabetic nephropathy, designed to help the body maintain a relatively good nutritional status, while reducing the accumulation of excess waste in the patient's body and alleviating uraemia-related symptoms
as much as possible.
Protein intake is of great significance
in the dietary management of patients with diabetic nephropathy.
The protein intake should be mainly
high-quality protein with high biological potency obtained from poultry, fish, soybeans and plant protein.

It is recommended that patients with diabetic nephropathy add essential amino acids or nitrogen-free protein precursors such as α-ketoacids to a low-protein diet to maintain or improve the nutritional status of diabetic nephropathy patients to delay the progression of
kidney disease.

4.
Limit sodium intake

High salt intake increases the risk
of progression to renal failure, cardiovascular and cerebrovascular disease, and death.
Limiting sodium intake in patients with diabetic nephropathy lowers blood pressure, lowers proteinuria, and reduces the risk of
cardiovascular events.

It is recommended that patients with diabetic nephropathy limit sodium chloride intake to less than 5.
0 g/day, but attention should be paid to individualized adjustment, and attention should be paid to appropriate water intake to avoid the occurrence
of hyponatremia.

Of course, in addition to lifestyle management, blood sugar control, blood pressure control, blood lipid regulation, uric acid control, proteinuria and so on
should be controlled under the guidance of a doctor.

Source: China Medical Tribune Diabetes Today

Compiled from Li Qingke, "Guidelines for the Prevention and Treatment of Diabetic Nephropathy in China"