Diabetic nephropathy is a complex of pathological changes in the blood vessels of the kidneys observed in both types of diabetes mellitus. This complication is diagnosed in about 10-20% of patients with diabetes mellitus.
Causes of diabetic nephropathy
The main factors provoking the development of the disease, are hyperglycemia (high blood sugar) and a long incomplete compensation of violations of carbohydrate metabolism. As a result of this, the biochemical processes gradually change: a violation of water-electrolyte homeostasis, the exchange of fatty acids, a decrease in the transport of oxygen,
Glucose acts toxic on the cells of the kidneys, as well as activates mechanisms that cause damage and increase the permeability of their walls. Due to damage to the nervous system in diabetes mellitus, renal vessels increase pressure, and damaged vessels are replaced by connective tissue. Also, a role in the development of diabetic neuropathy is played by arterial hypertension and malfunctions of the intrarenal blood flow, as well as a genetic factor.
Symptoms and stages of diabetic nephropathy
In the development of this complication, five stages are distinguished, three of which are preclinical, i.e. Diabetic nephropathy initially has no external manifestations and can only be determined by special laboratory methods or by biopsy. Nevertheless, the detection of pathology in the initial stages is very important, because Only in this period it is still reversible. Let us consider in more detail what changes are observed at each stage of the disease.
Stage I - increased sizes of renal cells, increased excretion and filtration of urine (hyperfunction of organs).
II stage - occurs approximately 2 years after the onset of diabetes. The thickening of the walls of the renal vessels is characteristic.
Stage III - significant damage to the kidney vessels, microalbuminuria (a small amount of protein in the urine), a change in the glomerular filtration rate.
IV stage - occurs 10 to 15 years after the onset of diabetes. Characteristic features are:
- proteinuria (allocation of a significant amount of protein in the urine);
- severe swelling in the legs, face, abdominal cavity, etc .;
- decreased body weight;
- weakness;
- nausea;
- thirst;
- frequent headaches ;
- increase in blood pressure.
V stage - almost complete vascular sclerosis, a significant decrease in excretory and concentration functions of the kidneys. Other signs are:
- massive proteinuria;
- the development of anemia;
- severe swelling;
- reduction of hyperglycemia;
- dyspeptic syndrome;
- uremia, etc.
How to treat diabetic nephropathy?
In the treatment of pathology, there are three main components:
- maintaining the optimal level of sugar in the blood;
- Therapy of arterial hypertension with microalbuminuria;
- prevention of a rapid decline in kidney function and the development of an anuric stage of renal failure;
- detoxification therapy.
In the treatment of diabetic nephropathy, the use of such groups of drugs is indicated:
- hypoglycemic preparations;
- inhibitors of the angiotensin-converting enzyme;
- angiotensin receptor antagonists;
- beta-blockers;
- calcium channel blockers;
- preparations for the normalization of the lipid spectrum of the blood;
- diuretics ;
- sorbents;
- antizotemics and others.
It requires compliance with low-protein and salt-free diets, reducing the consumption of fats. If the kidney function is violated significantly, it is possible to administer replacement therapy (hemodialysis, permanent peritoneal dialysis) or surgical treatment by donor kidney transplant.