1. Control blood sugar
Glycosylated hemoglobin (HbA1c) should be controlled at 7.0% or less. Strict control of blood sugar can partially improve renal blood flow abnormalities dynamics; at least in type 1 diabetes can delay the appearance of microalbuminuria; reduce existing microalbuminuria into clinically significant proteinuria.
2. Control of blood pressure
Diabetic nephropathy hypertension is not only common cause of diabetic nephropathy is also an important factor in the occurrence and development. Antihypertensive drug of choice for angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blocker (ARB). These drugs have improved renal hemodynamics, reduce urinary protein excretion, inhibiting mesangial cells, fibroblasts and macrophage activity, improve filtration membrane permeability and other pharmacological effects. Even under normal circumstances systemic blood pressure can produce kidney protection function, and does not depend on hemodynamic improvement buck. The main side effects of ACEI hyperkalemia, renal dysfunction, and dry cough. Blood pressure targets in blood pressure associated with proteinuria is 130 / 80mmHg. β-blockers and diuretics and lipid disorders because of their potential effect is not included in the first-line treatment advocate, unless the merger tachycardia or edema. Calcium channel blockers (CCB) renal protection in diabetic patients with nephropathy is not clear, but the role of diltiazem class seems superior to dihydropyridine class, which alone is not recommended for patients with diabetes nephropathy.
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3. Diet
High protein diets increase the glomerular perfusion, high filtration, and therefore advocates the principle of high-quality protein. Protein intake should be at a high biological potency of animal protein-based, early stage should be limited protein intake to 0.8g / (kg · d), has a large number of patients with proteinuria and kidney failure can be reduced to 0.6g / (kg · d). In patients with advanced renal dysfunction, should supplement α- keto acid. In addition, it was suggested to fish, chicken and other parts in place of red meat (such as beef, lamb, pork), and the addition of polyunsaturated fatty acids. Also do not unduly limit the vegetable protein such as soy protein intake.
4. The alternative treatment for end-stage renal disease
To end stage renal failure renal replacement therapy was feasible, but the prognosis is worse than non-diabetics.
Diabetic nephropathy patient's own common complications of diabetes, uremia early symptoms should be appropriate to relax the indications for renal replacement therapy. General endogenous creatinine clearance rate dropped to 10 ~ 15ml / min or associated with significant gastrointestinal symptoms, high blood pressure and heart failure is not easy to control who can enter hemodialysis. Hemodialysis and peritoneal dialysis is similar long-term survival, the former in favor of glycemic control, dialysis adequacy is good, but difficult to establish arteriovenous fistula, cardiovascular and cerebrovascular accident prone during dialysis; the latter are often used in continuous ambulatory peritoneal dialysis ( CAPD), has the advantage of short-term help to protect the residual renal function, because it does not have to use anticoagulants in patients with existing cardiovascular and cerebrovascular accident can also be implemented, but with glucose as osmotic solutes patient's blood glucose levels are difficult to control.
5. Organ Transplantation
For patients with end-stage diabetic nephropathy, kidney transplantation is the most effective treatment in the United States accounted for about 20% of kidney transplant patients. In recent years cadaveric renal transplantation 5 year survival rate was 79%, living donor kidney transplantation was 91%, while receiving dialysis 5-year survival rate of only 43%. In particular, relatives living kidney donor kidney survival rate was significantly higher than those of cadaveric renal transplantation. However, graft survival in diabetic patients with nephropathy is still 10% lower than non-diabetic patients. Kidney transplantation alone does not prevent the recurrence of diabetic nephropathy can not improve other diabetic complications.
Organ transplantation of kidney and pancreas may make patients glycosylated hemoglobin and serum creatinine levels returned to normal, and improving other diabetic complications, so the patient's quality of life is better than in renal transplant recipients.
